Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Background Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model. Methods Consecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call. Results The Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care. Conclusions Our data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Review of refugee mental health interventions following resettlement : best practices and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.

Review of refugee mental health assessment: Best practices and recommendations

This article focuses on mental health assessment of refugees in clinical, educational and administrative-legal settings in order to synthesise research and practice designed to enhance and promote further development of culturally appropriate clinical assessment services during the refugee resettlement process. It specifically surveys research published over the last 25 years into the development, reliability measurement and validity testing of assessment instruments, which have been used with children, adolescents and adults from refugee backgrounds, prior to or following their arrival in a resettlement country, to determine whether the instruments meet established crosscultural standards of conceptual, functional, linguistic, technical and normative equivalence. The findings suggest that, although attempts have been made to develop internally reliable, appropriately normed tests for use with refugees from diverse cultural and linguistic backgrounds, matters of conceptual and linguistic equivalence and test–retest reliability are often overlooked. Implications of these oversights for underreporting refugees' mental health needs are considered. Efforts should also be directed towards development of culturally comparable, valid and reliable measures of refugee children's mental health and of refugee children's and adults' psychoeducational, neuropsychological and applied memory capabilities.

Testing the vision: Preschool settings as places for meeting, bonding and bridging

The OECD (2006 Starting Strong II: Early Childhood Education and Care. OECD Publishing: Paris) envisions early childhood education and care settings as meeting places for diverse social groups; places that build social capital. This vision was assessed in a comparison of three preschools types: full-fee paying, subsidised-fee and publicly funded. The social composition within each was examined and the connectedness of the children (n = 472) who attended compared. Publicly funded preschools had more socially diverse populations. The quantity of social connectedness did not differ but children in publicly funded preschools described higher quality social relationships. Not all preschool settings are socially diverse but, where they are, the quality of relationships is highest.

Preferences of first-time expectant mothers for care of their child : 'I wouldn't leave them somewhere that made me feel insecure'

Australia has witnessed a continual increase in maternal employment over the past two decades, which places focus on both supply of childcare and a demand for high quality care. This study examined childcare preferences regarding the return to paid work of 124 Australian women who were expecting their first child. In contrast with most studies that have retrospective designs, the design of this study presents the perspectives of women prior to the birth of their first child-that is, before they have made a final decision about child care. This study found that the majority (78 per cent) of the women intended to re-commence work within the 12 months after the birth of their child. There were two factors that were the most salient features in their decision making-the quality of care and the personal satisfaction of engaging in paid work. The findings suggest that family friendly employment practices and access to secure, high-quality child care are key to women's secure participation in the paid workforce.

Ethical tensions and academic leaders

Internationally universities have been characterised by shrinking government funding, fierce competition for student enrolments, and greater pressures to become commercially viable. It is against this complex background that academic leaders have been required to confront and resolve a multitude of conflicting interests as they seek to balance a variety of values in their decision-making processes. In this article we put forward a model of ethical decision-making developed from empirical research and literature. To test the efficacy of the model, a case scenario is posed. The article concludes by raising a number of implications for academic leaders regarding ongoing professional learning needed in this area.

The accidental mentor : Australian rural nurses developing supportive relationships in the workplace

improved rural nurse retention as an outcome of recognising and developing such supportive relationships in the workplace. Strategies include: performance review and development processes that account for all forms of supportive relationships conducted in the workplace; recognising the importance of developing supportive relationships and allocating time for these; and continuing professional development designed to meet local needs for developing a culture of support in the workplace.

Getting to know a stranger-rural nurses' experiences of mentoring : a grounded theory

Background: Mentoring is often proposed as a solution to the problem of successfully recruiting and retaining nursing staff. The aim of this constructivist grounded theory study was to explore Australian rural nurses' experiences of mentoring. Design: The research design used was reflexive in nature resulting in a substantive, constructivist grounded theory study. Participants: A national advertising campaign and snowball sampling were used to recruit nine participants from across Australia. Participants were rural nurses who had experience in mentoring others. Methods: Standard grounded theory methods of theoretical sampling, concurrent data collection and analysis using open, axial and theoretical coding and a story line technique to develop the core category and category saturation were used. To cultivate the reflexivity required of a constructivist study, we also incorporated reflective memoing, situational analysis mapping techniques and frame analysis. Data was generated through eleven interviews, email dialogue and shared situational mapping. Results: Cultivating and growing new or novice rural nurses using supportive relationships such as mentoring was found to be an existing, integral part of experienced rural nurses' practice, motivated by living and working in the same communities. Getting to know a stranger is the first part of the process of cultivating and growing another. New or novice rural nurses gain the attention of experienced rural nurses through showing potential or experiencing a critical incidence. Conclusions: The problem of retaining nurses is a global issue. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses-many already do so. Recognising this role and providing opportunities for development will help grow a positive, supportive work environment that nurtures the experienced nurses of tomorrow.

Live my work : rural nurses and their multiple perspectives of self

Aim. This paper is a report of a study to explore rural nurses' experiences of mentoring. Background. Mentoring has recently been proposed by governments, advocates and academics as a solution to the problem for retaining rural nurses in the Australian workforce. Action in the form of mentor development workshops has changed the way that some rural nurses now construct supportive relationships as mentoring. Method. A grounded theory design was used with nine rural nurses. Eleven semi-structured interviews were conducted in various states of Australia during 2004-2005. Situational analysis mapping techniques and frame analysis were used in combination with concurrent data generation and analysis and theoretical sampling. Findings. Experienced rural nurses cultivate novices through supportive mentoring relationships. The impetus for such relationships comes from their own histories of living and working in the same community, and this was termed 'live my work'. Rural nurses use multiple perspectives of self in order to manage their interactions with others in their roles as community members, consumers of healthcare services and nurses. Personal strategies adapted to local context constitute the skills that experienced rural nurses pass-on to neophyte rural nurses through mentoring, while at the same time protecting them through troubleshooting and translating local cultural norms. Conclusion. Living and working in the same community creates a set of complex challenges for novice rural nurses that are better faced with a mentor in place. Thus, mentoring has become an integral part of experienced rural nurses' practice to promote staff retention. © 2007 The Authors.

Walking with another : rural nurses' experiences of mentoring

The aim of this constructivist grounded theory study was to explore rural nurses' experiences of mentoring. Mentoring is often proposed as a solution to the problem of nursing workforce shortages. The global problem of workforce for nurses can be defined using the parameters of recruitment and retention rates, 'problems' with which result in staff shortages, particularly of experienced nurses. Constructivist grounded theory has its foundations in relativism and an appreciation of the multiple truths and realities of subjectivism. Seven Australian rural nurses were interviewed. To ensure data saturation of particular categories and the fit of tentative theoretical conceptualisations, two participants were interviewed twice with no new codes identified from the subsequent interviews. Cultivating and growing new or novice rural nurses was the core category which conceptualised a two-part process consisting of getting to know a stranger and walking with another. Supportive relationships such as mentoring were found to be an existing, integral part of experienced rural nurses' practice - initiated by living and working in the same community. In this grounded theory, cultivating and growing is conceptualised as the core category. A two-part process was identified - getting to know a stranger and walking with another. This paper examines one of these subcategories, walking with another, relating the ways in which experienced rural nurses walk with another by firstly keeping things in perspective for new or novice rural nurses, and secondly using a particular form of language called nurse chat. For experienced rural nurses, mentoring in this way delivers a number of different outcomes with various nurses. Because it is a part of the experienced rural nurse's practice on an ongoing basis, individual mentoring relationships do not provide an end in relation to this nurse's experiences of mentoring, rather they are part of an ongoing experience. Creating supportive environments that include developing relationships such as mentoring is a potential solution to local staffing needs that does not require intensive resources. Experienced nurses engaged in clinical practice have the potential to cultivate and grow new or novice nurses - many already do so. Recognising their role and providing support as well as development opportunities will bring about a cycle of mentoring within the workplace. © 2008 Sage Publications.

Parental bonding and alexithymia : a meta-analysis

Aim: The primary purpose of this meta-analysis was to explore, clarify and report the strength of the relationship between alexithymia, as measured by the Toronto Alexithymia Scale (TAS-20), and parenting style as measured by the Parental Bonding Instrument (PBI). Methods: Web of Science, PsycInfo, PubMed and ProQuest: Dissertations and Theses searches were undertaken, yielding nine samples with sufficient data to be included in the meta-analysis. Results: Evidence indicated moderate to strong relationships between maternal care and alexithymia, and between maternal care and two of the three TAS-20 alexithymia facets (Difficulties Describing Feelings and Difficulties Identifying Feelings, but not Externally Oriented Thinking). Moderate relationships were observed for both maternal- and paternal-overprotection and alexithymia respectively, and for overprotection (both maternal and paternal) and Difficulties Describing Feelings. Conclusion: This study is the first meta-analysis of the relationship between parenting styles and alexithymia, and findings confirm an especially strong association between maternal care and key elements of alexithymia. This review highlights the issues that still remain to be addressed in exploring the link between parenting style and alexithymia.

Supporting refugee students in schools : what constitutes inclusive education?

The worldwide rise in numbers of refugees and asylum seekers suggests the need to examine the practices of those institutions charged with their resettlement in host countries. In this paper we investigate the role of one important institution – schooling – and its contribution to the successful resettlement of refugee children. We begin with an examination of forced migration and its links with globalisation, and the barriers to inclusion confronting refugees. A discussion of the educational challenges confronting individual refugee youth and schools is followed by case studies of four schools and the approaches they had developed to meet the needs of young people from a refugee background. Using our findings and other research, we outline a model of good practice in refugee education. We conclude by discussing how educational institutions might play a more active role in facilitating transitions to citizenship for refugee youth through an inclusive approach.

Doorway to research : Issues in the development of an interactive website for international graduate students

This paper describes results of a study evaluating the content, functionality and design features of an innovative online website called the Doorway to Research (http://rsc.acid.net.au/Main.aspx) , which was developed to support international graduate students studying at universities in Australia. First, the key features of the website are described. Second, the result of a pilot study involving 12 students and faculty members who tested key aspects of the design, content and functionality of the website and provided written and oral feedback base on task-based questions and focus group discussions are explored. Finally, recommendations for future development are presented. Results of the study indicate general student satisfaction with the website and its design, content and functionality, with specific areas identified for further development.