Identifying the health and mental health information needs of people with coronary heart disease, with and without depression

Objective:
To identify the health and mental health information needs of people with coronary heart disease (CHD), with and without comorbid depression.

Design and setting:
A qualitative study conducted in Melbourne in 2006, using thematic analysis of semi-structured interviews on the types of health information that patients with CHD considered useful to assist with the management of their illness. Structured clinical interviews were used to assess current and prior depressive episodes in these patients.

Participants:
14 general practice patients (eight with current or prior history of major depression) who had experienced myocardial infarction, coronary artery bypass graft surgery, angioplasty or angina (confirmed via testing).

Results:
Four themes relating to information on how patients could manage their cardiovascular health and improve their psychosocial wellbeing emerged: psychosocial; physical activity; medical; and information for family. The most prominent information needs included identification and management of risk-related physical symptoms, and psychosocial information, most notably to enhance patients’ social support. Patients considered this information important for alleviating health anxiety and negative affect.

Conclusion:
This small patient sample endorsed the need for health and mental health information on a range of psychosocial and physical health topics. Participants desired specific types of information to assist with the self-management of their health and to assuage their health concerns.

Doctoral graduates in mental health nursing in Victoria, Australia : the doctoral experience and contribution to scholarship

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

Buffering effect of leisure self-determination on the mental health of older adults

Leisure self-determination was tested for its capacity to buffer the effects of life stress on the level of depression of older adults. A direct association between leisure-self-determination and level depression was also tested. A sample of 152 individuals aged 49 years and over completed a questionnaire which included measures of stress, leisure self-determination, and depression. Hierarchical multiple regression analysis incorporating an interaction component to represent the buffering effect was used to analyse the data. Higher levels of leisure self-determination were significantly associated with lower levels of depression regardless of life stress. Leisure self-determination also acted as a buffer of the association between life stress and depression. The study has significant theoretical and practical implications. Theoretically, it supports the stress buffering hypothesis of Coleman and Iso-Ahola (1993) when applied to a sample of older adults. The practical implications of the empirical evidence focus on the importance of fostering leisure self-determination dispositions through leisure practices, policies, and leadership styles that facilitate and support older adult autonomy in leisure experiences.

Practical application of the Delphi technique in a bicultural mental health nursing study in New Zealand

Background. Numerous studies have employed the Delphi technique to seek expert opinion about aspects of clinical practice. When researching literature on the Delphi technique, however, we discovered discrepancies in its application, and a lack of detail when reporting design, administration, and analysis methods. Such lack of specificity hinders the replicability and assessment of the clinical and cultural validity and reliability of Delphi studies.

Aim. The aim of this paper is to detail the practical application of the Delphi technique as a culturally and clinically valid means of accessing expert opinion on the importance of clinical criteria.

Methods. Reference is made to a bicultural New Zealand mental health nursing clinical indicator study that employed a three-round reactive Delphi survey. Equal proportions of Maori and non-Maori nurses (n = 20) and consumers (n = 10) rated the importance of 91 clinical indicator statements for the achievement of professional practice standards. Additional statements (n = 21) suggested by Delphi participants in round 1 were included in subsequent rounds. In round 2, participants explained the rating they applied to statements that had not reached consensus in round 1, and summarized responses were provided to participants in round 3. Consensus was considered to have been achieved if 85% of round 3 ratings lay within a 2-point bracket on the 5-point Likert-scale overall, or in one of the Maori nurse, non-Maori nurse, or consumer groups. A mean rating of 4·5 after round 3 was set as the importance threshold.

Findings. Consensus occurred overall on 75 statements, and within groups on another 24. Most statements (n = 86) reached the importance benchmark.

Conclusions. When rigorous methods of participant selection, group composition, participant feedback, and determination of consensus and importance are employed, the Delphi technique is a reliable, cost-effective means of obtaining and prioritizing experts judgements.

Development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand

This paper reports the three-stage development of a professional practice audit questionnaire for mental health nursing in Aotearoa/New Zealand. In Study 1, clinical indicator statements (n = 99) generated from focus group data, which were considered to be unobservable in the nursing documentation in consumer case notes, were included in a three-round Delphi process. Consensus of ratings occurred for the mental health nurse and academic participants (n = 7) on 83 clinical indicator statements. In Study 2, the clinical indicator statements (n = 67) that met importance and consensus criteria were incorporated into a questionnaire, which was piloted at a New Zealand mental health service. The questionnaire was then modified for use in a national field study. In Study 3, the national field study, registered mental health nurses (n = 422) from 11 New Zealand District Health Board mental health services completed the questionnaire. Five categories of nursing practice were identified: professional and evidence-based practice; consumer focus and reflective practice; professional development and integration; ethically and legally safe practice; and culturally safe practice. Analyses revealed little difference in the perceptions of nurses from different backgrounds regarding the regularity of the nursing practices. Further research is needed to calibrate the scores on each clinical indicator statement with behaviour in clinical practice.

New Zealand development and trial of mental health nursing clinical indicators - a bicultural study

This paper describes the development and validation of bicultural clinical indicators that measure achievement of mental health nursing practice standards in New Zealand (ANZMCHN, 1995, Standards of practice for mental health nursing in New Zealand. ANZCMHN, Greenacres). A four-stage research design was utilised including focus groups, Delphi surveys, a pilot, and a national field study, with mental health nurses and consumers as participants. During the national field study, consumer files (n=327) from 11 District Health Boards, and registered nurses (n=422) completed an attitude questionnaire regarding the regularity of specific nursing and service activities. Results revealed a variation in the mean occurrence of the clinical indicators in consumer case notes of 18.5–89.9%. Five factors with good internal consistency, encompassing domains of mental health nursing required for best practice, were derived from analysis of the questionnaire. This study presents a research framework for developing culturally and clinically valid, reliable measures of clinical practice.

The impact of workload on wellbeing, mental health and depression : a longitudinal study of work perception

This paper explores the relationships between characteristics of the job (workload, control and support) and organizational justice (distributive, procedural, interpersonal and informational) at Time 1, onto three indicators of psychological health at Time 2 (psychological wellbeing, distress and depression). The sample consisted of sworn members of a state-based police force (n=143). Hierarchical regression analyses indicated that workload was associated with psychological wellbeing, distress and depression at the one-year follow-up. Specifically, high workload at Time 1 was associated with psychological distress and depression at Time 2, and low workload was associated with psychological wellbeing at Time 2. Further, there was a significant relationship between perceived informational justice at Time 1 and psychological wellbeing at Time 2. No significant interaction effects were demonstrated for the job characteristics or organizational justice onto psychological health status. That is, longitudinally, workload directly influences both positive and negative mental health, and informational justice is related to psychological wellbeing. The implications for the demand-control-support model are discussed. The injustice-as-stressor argument was generally not supported.

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.

Factors associated with dropout and diagnosis in child and adolescent mental health services

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors.

Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories.

Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses.

Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.