Clinical placements in mental health: a literature review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students' skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.

Development, reliability and validity of a tool, to measure emergency department clinicians' attitudes towards family presence (FP) during acute deterioration in adult patients.

Despite many studies of family presence during resuscitation, no validated tool exploring the attitudes and beliefs of healthcare staff towards family presence has been published. The aim of this paper is to describe the development of a tool to accurately measure the attitudes and beliefs of emergency department staff towards family presence in the deteriorating adult patient, present the results of validity and reliability testing, and present the final validated tool. Twenty-nine items were developed, informed by themes from the literature and unvalidated published tools related to family presence during resuscitation. The tool was piloted on a sample of 68 emergency nursing and medical staff. Content validity and face validity were established using feedback from participants. Reliability was established by unidimensionality, exploratory factor analysis and internal consistency. Sixteen items were deleted from the original tool due to low item-to-total correlations and low communalities. Exploratory factor analysis of the remaining items revealed four factors with acceptable correlation coefficients and appropriate explanation of variance. Cronbach's alpha for each factor was >0.7 indicating a high degree of internal consistency. The four factors were labelled and arranged in a logical order to form the final tool, the Emergency Department Family Presence Survey.

Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder : randomized controlled trial

Objective: The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made.

Method: A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance.

Results: Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=−3.45, p=0.002, d=0.43 and t(65)=−5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings.

Conclusions: Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.

Staff behaviour and resident engagement before and after active support training

Background Identifying the factors associated with greater increases in resident engagement has the potential to enhance the effectiveness of active support (AS).

Method Observational data from Stancliffe, Harman, Toogood, and McVilly's (2007) study of AS were analysed to evaluate amount of staff help, effectiveness of staff help, and staff use of praise.

Results Lag analyses showed that antecedent staff help was consistently followed by resident engagement at pre-test. This strong association did not increase significantly at post-test. Resident engagement was more likely to follow staff help than the other way around. There was an increase from pre-test to post-test in help and praise by staff. The higher absolute amount of praise was largely the result of the increase in staff help.

Conclusions The amount of staff help, its effectiveness, and use of praise by staff may each be important in increasing engagement. These factors should continue to be the focus of research attention and applied efforts to help ensure active support is consistently effective.

Attitudes of mental health staff to routine outcome measurement

Background: Routine outcome measurement is mandated in public mental health services in Australia, but uptake and compliance are variable. This may be because of uncertainties and resistances among clinicians.
Aims: To survey attitudes and practices to routine outcome measurement among staff in adult area mental health services and to elucidate their correlates.
Method: As part of a larger study, a specifically designed questionnaire was distributed to all staff.
Results: A high return rate was achieved. A wide range of opinion was found. Staff who had attended training reported the measures as easier to use than those who had not. Staff who had recently seen feedback rated outcome measures as more valuable but less easy to use than those who had not seen feedback. Compared to other disciplines, medical staff and psychologists tended to rate outcome measures as less useful.
Conclusions: The results have implications for the implementation and sustainability of routine outcome measurement. They highlight the need for staff to receive targeted training and usable reports, and to have access to resources to extract meaning and value from outcome measures.

Staff perspectives of drug use issues among sex-on-premises attendees

Aims: Sex on premises venues (SOPV) have been given considerable attention, in particular when exploring the relationship between SOPV attendance and risk behaviours such as drug use and unsafe sex. Little attention has been given to the perspectives of those who work in these venues.

Methods: Semi-structured interviews were conducted with staff recruited from four SOPV in Sydney, Australia. Content analysis was performed to identify common themes.

Findings: Several themes emerged from the staff interviews. These themes concentrated on particular drugs of concern; interventions in place to deal with substance use and those under the influence; and that drug use among SOP patrons occurred at venues prior to attending SOPV.

Conclusions: Interviews with SOP workers showed that these venues face unique challenges that may not be encountered by other settings. SOPV staff has a detailed understanding of their clientele and their perspectives may be important not only when informing trends in substance use but also the development and distribution of harm reduction materials.

The impact of bullying on health care administration staff : reduced commitment beyond the influences of negative affectivity

Background: Investigations of workplace bullying in health care settings have tended to focus on nurses or other clinical staff. However, the organizational and power structures enabling bullying in health care are present for all employees, including administrative staff.

Purposes: The purpose of this study was to specifically focus on health care administration staff and examine the prevalence and consequences of workplace bullying in this occupational group.

Methodology/Approach: A cross-sectional study was conducted based on questionnaire data from health care administration staff who work across facilities within a medium to large health care organization in Australia. The questionnaire included measures of bullying, negative affectivity (NA), job satisfaction, organizational commitment, well-being, and psychological distress. The three hypotheses of the study were that (a) workplace bullying will be linked to negative employee outcomes, (b) individual differences on demographic factors will have an impact on these outcomes, and (c) individual differences in NA will be a significant covariate in the analyses. The hypotheses were tested using t tests and analyses of covariances.

Findings: A total of 150 health care administration staff completed the questionnaire (76% response rate). Significant main effects were found for workplace bullying, with lower organizational commitment and well-being with the effect on commitment remaining over and above NA. Main effects were found for age on job satisfaction and for employment type on psychological distress. A significant interaction between bullying and employment type for psychological distress was also observed. Negative affectivity was a significant covariate for all analyses of covariance.

Practice Implications: The applications of these results include the need to consider the occupations receiving attention in health care to include administration employees, that bullying is present across health care occupations, and that some employees, particularly part-time staff, may need to be managed slightly differently to the full-time workforce.

A theoretical framework of entrepreneurship and innovation in healthcare organisations

This paper examines the role of entrepreneurship and innovation in the context of healthcare management by offering a number of research propositions. In recent years, hospitals have attracted ever growing commentary about rising costs and the need for improving information technology systems. Whilst there have been some service innovations introduced from other industries, particularly the manufacturing industry, there have been few service innovations originating from the healthcare sector. In the healthcare sector, there are a number of service innovations, which are discussed in this paper in terms of their relevance to managerial roles of hospital staff members. In addition, this paper examines the role of entrepreneurial managers in determining innovative technology behaviour in healthcare organisations. Literature from innovation management, corporate intrapreneurship and healthcare management is used to explain the findings of this paper and future areas of research are also proposed.

Evaluation of building performance for strategic facilities management in healthcare : a case study of a public hospital in Australia

Purpose - This paper evaluates the main elements of building performance namely building function, building impact and building quality in order to promote strategic facilities management in healthcare organisation to improve core (health) business activities. Design/methodology/approach - Based on current available toolkits, a questionnaire is issued to healthcare users (staff) in a public hospital about their level of agreement in relation to these elements. Statistical analysis is conducted to regroup the elements. These regrouped elements and their inter relationships are used to develop a framework for measuring building performance in healthcare buildings. Findings - The analysis helped to clarify the understanding and agreement of users in Australian healthcare organisation with regards to building performance. Based on the survey results, 11 new elements were regrouped into three groups. These new regrouped elements will be used to develop a reliable framework for measuring performance of Australian healthcare buildings. Originality/value - Currently there is no building performance toolkit available for Australian healthcare organisation. The framework developed in this paper will help healthcare organisations with a reliable performance tool for their buildings and this will promote strategic facilities management.

Evaluating health services with point of service feedback: perspectives and experiences of patients, staff and community volunteers in an inpatient rehabilitation facility

PURPOSE: To determine patient, staff and community volunteer opinions and experiences of point of service feedback (POSF) in an inpatient rehabilitation facility. METHOD: Participants were recruited by purposeful sampling. Two researchers conducted in-depth semi-scripted interviews with patients, staff or volunteers until no new issues emerged. Manually transcribed interview data underwent thematic analysis that grouped information into categories of related information. RESULTS: Twenty patients, 26 staff from 10 different professional groups, and 2 community volunteers were interviewed. Patient and volunteer data were grouped into five main categories: patients wanted their voice heard and acted on; patients could be positively and negatively affected by POSF; patients could be reluctant to evaluate staff; patients preferred POSF to post-discharge mailed questionnaires; and patients' feedback was influenced by the data collector. Staff wanted: feedback to help them improve the patient experience; and feedback that was trustworthy, usable and used. Staff believed that the feedback-collector influenced patients' feedback and affected how feedback could be used. CONCLUSIONS: Patients, staff and community volunteers identified issues that determine the appropriateness and usefulness of POSF. Policy and practise should address the preferences, needs and experiences of health service users and providers so that POSF produces maximum benefits for both patients and health services. Implications for Rehabilitation POSF can enhance patients' experiences of inpatient rehabilitation by providing a mechanism to be heard and communicating that patients are valued; care must be exercised with patients who find giving feedback stressful. Collecting POSF is most beneficial when coupled with methods to efficiently and effectively respond to feedback. POSF requires interpretation in light of its limitations including patients' ability to accurately and unreservedly communicate their experiences. Who collects POSF requires careful consideration; community volunteers have both advantages and disadvantages.

Assessing the clinical competence of psychology students through Objective Structured Clinical Examinations (OSCEs): student and staff views

Objective Structured Clinical Examinations (OSCEs) are a well-known, reliable, and valid assessment method used across the healthcare sector. In the present study, we applied OSCEs in three units within professional postgraduate psychology courses, with the broad aims of identifying staff and student perceptions of the assessment. At the conclusion of each OSCE, staff and students completed a feedback questionnaire that contained both scaled and open-ended questions. Results suggest that clinical psychology OSCEs can be stressful for students, but are also well regarded. Both staff and students felt that the OSCEs were realistic, valid, and aligned well with professional practice. Students reported differences in the way in which they prepared for the OSCEs compared with a written exam or other form of assessment, while staff noted that models of OSCE development must be flexible, to adequately assess the objectives of individual units. Further, because they can be a costly exercise, OSCEs need to be applied judiciously within the tertiary sector.

Health services should collect feedback from inpatients at the point of service: opinions from patients and staff in acute and subacute facilities

OBJECTIVE: Point of service feedback (POSF) enables patients to give health services feedback about their experiences during or immediately after care. Despite the increasing use of POSF, little is known regarding patients' and staffs' opinions of this practice and whether they consider it acceptable or useful. The study aimed to determine patient and staff opinions regarding POSF. DESIGN: A cross-sectional survey. SETTING: Acute and subacute healthcare facilities. PARTICIPANTS: Two hundred and forty-seven patients and 221 staff. RESULTS: Participants indicated that patients should be invited to evaluate health services when they are in hospital or subacute care and improving services was the most important reason for doing so. Staff indicated that:• collecting patients' feedback during their stay was an important part of providing care and not an interruption to it (n = 187 of 221, 85%).• collecting patients' feedback was best done with a variety of methods; talking directly with patients during their stay was the preferred option (n = 161 of 219, 74%).More patients preferred to:• give feedback during their stay (51%) than after discharge from care (15%).• give feedback by talking with someone (45%) than completing a questionnaire (31%).Some patients (14%) were concerned about reprisal from staff if they gave negative feedback. CONCLUSIONS: POSF can be acceptable and useful for evaluating health services and should be incorporated into a person-centred approach that allows patients to choose from a variety of feedback options both during and after their stay. To be most useful, feedback should be incorporated into a quality improvement system.

Factors influencing compliance to universal precautions in healthcare workers: a systematic literature review

Background: Occupational exposure to blood borne viruses involving hollow bore needles is one of the most commonly reported adverse events affecting staff in the National Health Service in the UK. Universal Precautions Guidelines were originally developed in 1987 in order to minimise the risk of contact with body fluid. Universal precautions not only protect staff against blood borne pathogens but are also considered as an efficient mean to reduce the spread of pathogens from patients to patients via healthcare workers.Aim of the study: The aim of this study was to identify and evaluate the objective evidence on factors influencing healthcare workers compliance to universal precautions through a systematic literature review.Methodology: This systematic review was conducted in 2009 and studies were retrieved through electronic databases, manual journal searches and communications with experts in the field. Studies of cross sectional survey design and observational design were included in the review as they constituted the most commonly used research design evaluating compliance to universal precautions.A quality checklist was developed based on existing assessment criteria.Findings: Studies conducted to ascertain compliance to universal precautions are plentiful but remain of low quality. Sixty studies were retrieved and evaluated for potential inclusion in this study. Four studies met the inclusion criteria. Three were of cross-sectional survey design and one of direct observational design.Conclusions: Uptake of universal precautions remains low despite known benefits. Lack of time, resources and lack of knowledge have been shown as being factors negatively influencing healthcare workers compliance with universal precautions.This paper also highlights the issues surrounding the inclusion of low grade evidence in systematic literature reviews and the implications of reviews including low grade evidence on practice.Type of article: Research paperKeywords: systematic review, universal precautions, standard precautions, compliance, healthcare worker.