This paper reviews the main strategies for screening and assessing the needs of the diverse range of socially excluded clients who come into contact with statutory and non-statutory agencies. A high level aim of contemporary UK health and social policy is to engage with those who are hard to reach with traditional health service provision. The initial contact and screening processes, therefore, are central to developing a relationship with the client and engaging him/her with the main stream community services. Many homeless and socially excluded people have multiple and complex needs but seeking accommodation provides a good opportunity to begin to engage the client with support services. Although substance misuse and mental health problems might not be immediately apparent, screening and subsequent assessment of these aspects of dual diagnosis should be provided in order for appropriate help to be made available. Ongoing monitoring of the client's progress will provide an insight into the cues which indicate relapse. However, an important aspect of inclusion often involves gaining access to meaningful work. The neurocognitive ability of the client to undertake work and become socially integrated may be limited by problems in decision making and other cognitive skills. Appropriate support, in these cases, might involve an evaluation of neurocognitive deficits and the guidance to appropriate employment tasks. The encouragement of positive health behaviours, including improvements in nutritional status will all add to the increased possibility of coming in from the cold.
To review the psychiatric and obstetric complications of pregnancy in women with psychotic disorders and discuss implications for prevention and treatment of these conditions. Narrative review. Many women with psychotic disorders have children but their pregnancies are at an increased risk of obstetric complications, stillbirths and neonatal deaths, and psychiatric complications. Women with a history of mood disorders (affective psychoses) are at high risk of postpartum relapse. A significant proportion of mothers with psychotic disorders have parenting difficulties and lose custody of their infant. Close liaison between all health professionals during pregnancy and postpartum is essential for optimal management of these high-risk pregnancies.
To examine one aspect of a larger study evaluating the modern matron role, comparing trust nursing directors' perceived outcomes of introducing matrons to the NHS with actual evidence of such outcomes gathered in ten subsequent case studies. In a national survey, nursing directors stated their perceived outcomes arising from introduction of matrons; these outcomes were compared with case study findings. Participants and settings: Questionnaire to Directors of Nursing in all 545 NHS trusts in England in 2003. Ten NHS trusts purposively selected to include different types in varied settings. Data collection involved interviews and questionnaires to matrons, other relevant staff and some patients, and use of routinely collected data. Sixty percent of 414 survey respondents reported positive outcomes such as improvements in staff management, leadership, patient environment and standards of care, whereas only 36% reported negative outcomes such as role ambiguity and role overload for matrons. Most of the reported positive outcomes were recognised in subsequent case studies. Positive outcomes attributed by directors of nursing to matron appointments appeared to outweigh negative outcomes. There was evidence of these positive outcomes in subsequent case studies.
This account demonstrates areas previously neglected in the cross-cultural research literature. The aim is to examine challenges which researchers may encounter when planning cross-cultural projects. Methodological issues arising while preparing a qualitative research project are compared with the literature. The research project, planned in Scotland, was undertaken in three industrial cities in China. Semi-structured interviews were planned with three groups of informants in each city. The informants were (1) women who had given birth by caesarean one week or one year previously (2) health care workers and (3) community members. The Scotland-based researchers kept notes of their experiences of preparing and beginning this project.
Delirium is a severe organic dysfunction of the brain with a decline in attention and cognition. It is characterized by an acute onset with a tendency to fluctuate and impaired consciousness with reduced clarity of awareness. Furthermore it is designated by a reduced ability to focus, sustain, or shift attention and a change in cognition or a perceptual disturbance with hallucinations.
This study explored everyday prospective memory deficits associated with excessive alcohol use in teenagers aged 16–19 years. Excessive and low-dose alcohol users completed the Prospective Memory Questionnaire, which measures self-reported everyday memory errors. After controlling for other drug use, excessive users reported significantly more everyday memory errors than low-dose controls.
The purpose of this article is to describe the barriers to creating breastfeeding friendly culture and strategies used to overcome these barriers by a tertiary level Health Centre and a Capital District Health Authority (CDHA) Public Health Services, with which the authors were affiliated. Lessons learned from this process may be a useful resource for other organizations embarking on this difficult, yet exciting journey.
Critically ill patients are exposed to a high degree of clinical risk and adverse events due to a number of factors including complex clinical interventions, polypharmacy, acuity and severity of illness, and a high level of physical dependency. The incidence of adverse events has been investigated as an indicator of quality of care and clinical risk. The purpose of this evaluation was to explore the nature of untoward clinical events (UCE) experienced by adult patients admitted to a high dependency unit in order to introduce an appropriate education and training programme. Twenty discrete assessments were carried out involving adult patients admitted to a high dependency unit. A systematic, in-depth assessment of each patient was undertaken by a critical care nurse consultant in order to identify UCE. Quantitative clinical data and descriptive data of diagnosis, clinical interventions, treatment and nursing care were collected. Quantitative data were analysed using SPSS version 11.5 for windows and descriptive data describing the nature and type of untoward clinical events were content analysed and coded into categories. Twenty-eight UCE were detected involving ten patients. Four categories of UCE were identified as deviation from treatment plans, hospital standards and guidelines; inaccurate information recorded/communicated influencing a patient's treatment/care; service/resource shortfalls; and inadequate treatment plans. All the events were seemingly preventable and mainly attributable to nursing practice although there were possibly a number of reasons why they occurred. Further research is needed to investigate the correlation of adverse events with organisational factors, nurse staffing and patient dependency.
Determinants of pediatric health care use extend beyond the health status of the child and economic and access considerations. Parental factors, particularly those associated with the mother, are critical. The common sense model of health and illness behaviors, which was developed to account for adult health care use, may constitute a framework to study the role of mothers in determining pediatric health care use. In the common sense model, the person's cognitive representations of and affective reactions to bodily states influence health care decision-making. There is a growing literature that points to the importance of maternal psychopathology (reflecting the affective component of the common sense model) and maternal parenting self-efficacy (reflecting the cognitive component of the model) as important contributors to pediatric health care use. The implications of this conceptualization for future research and clinical practice are discussed.
Most institutes who entered the Research Assessment Exercise (RAE) Unit of Assessment (UoA) 10 put forward several papers that are clearly not nursing in any meaningful way. 6.1% of all papers are neither papers about nursing, relevant to nursing, or in nursing journals. Non-nursing papers are associated with similar RAE scores as nursing papers. Those institutes that enter many non-nursing papers do not focus on one other area, but enter papers from several.
Few Quality of Life (QoL) instruments in use today were originally developed for older populations (75+). Information on their validity and reliability in this age group is sparse. The current study investigated the psychometric properties of the Life Quality Gerontological Centre Scale (LGC), a general QoL instrument designed for use among older people. A further aim was to describe and compare QoL with gender and in people needing help with Activities of Daily Living and those not needing such help. A postal questionnaire surveyed 1093 people (mean age 82.7, SD 5.3). Principal component analysis revealed that LGC was reasonably stable as the construct-and cross validation more or less replicated the suggested QoL factors. The instrument differentiated between needing help and not and between men and women. LGC needs further development with respect to reliability, face and content validity but is potentially useful as a diagnostic or an outcome assessment after interventions among older people. Individuals in need of help and women had lower scores in several QoL areas and in total QoL scores compared to those not needing help and men. Older people’s QoL may be improved by interventions directed to areas beyond health and physical functioning. Men and women might also benefit from different interventions directed towards QoL.
As the number of community-dwelling older adults increases, assisting them to maintain health is an optimal goal of care. Adherence to treatment plans, medical follow-up, and the participation in preventive health maintenance activities (PHMA) are primary approaches to health maintenance. But the impetus for this group to request or assent to PHMA remains unclear. Thus, the purpose of this study was to determine whether satisfaction with healthcare providers influenced community-dwelling older adults' participation in PHMA. A descriptive design was used to investigate whether healthcare satisfaction influenced participation in PHMA in a population of community-dwelling older adults. Thirty-nine community-dwelling older adults completed two questionnaires, participation in PHMA and the patient satisfaction in healthcare providers scale. The majority of participants were satisfied with their healthcare providers but that finding had little influence on PHMA participation. Healthcare provider satisfaction may play a limited part in influencing whether older adults participate in PHMA. The onus remains on the geriatric healthcare provider to educate, encourage, schedule, refer, and follow-up on the completion of PHMA to help safeguard the health of community-dwelling older adults.
To evaluate the use of a combined strategy (a nurse opinion-leader; evidence-based guidelines; a staff education programme and a new recording system) for the implementation of multidisciplinary stroke assessment in an acute hospital setting as measured by the compliance of different professional groups. A quasi-experimental study design utilising a pre-test/post-test group. Nine medical wards in a 600 bedded outer London Acute NHS Trust (without a stroke unit). 190 stroke patients (n = 98 pre-test vs n = 92 post-test). Professional compliance with assessment guidelines documented in the new recording system. Pre-test compliance with guidelines (n40) ranged from 0% to 100% and post-test ranged from 23–100%. Significant improvements (p < .05) in compliance were found in relation to 25 guidelines and a significant decline was documented in four others. Comparison of pre vs post-test values demonstrated variable changes in compliance with guidelines across professional groups: medical (range −64–+23%); nursing (range +2–+74%); physiotherapy (range −15–+69%); occupational therapy (range 0–+34%). The combined use of an opinion leader, guidelines, education and a recording system had a variable affect on compliance with guidelines; opinion-leadership appeared to have the most influence over compliance. The study design, and guideline specific features may have constrained changes in practice.
Alcohol consumption has increased in England over the last forty years and this has been associated with a rise in alcohol related health and social problems. Excessive alcohol consumption has an important effect on individuals and society, in addition is leading to a huge financial burden upon the National Health Service. This review looks at the need for accurate diagnosis of individuals as risk of developing alcohol related disease due to excess alcohol consumption. The biochemical markers currently available to health care professionals will be discussed and future markers currently being tested experimentally will also be highlighted upon. In current practice blood alcohol, mean corpuscular cell volume, gamma-glutamyl transferase, serum aminotransferases and carbohydrate deficient transferrin are used. In addition the combined use of clinical questionnaires and biochemical markers are discussed. Currently there are no perfect clinical markers available to diagnose excess alcohol consumption; however, further markers are being evaluated.
The objective of this study was to examine evidence of the effectiveness of interventions, particularly by midwives, to prevent postnatal depression, or by Health Visitors to treat postnatal depression. A literature search from 1966 to July 2005 covered health databases MEDLINE, CINAHL, EMBASE, and PsycINFO, and Evidence-Based databases in The Cochrane Library, covering the Cochrane Database of Systematic Reviews and the Cochrane Controlled Trials Register. Studies that evaluated maternal mood up to one year after delivery were reviewed. From the 37 published studies that involved an intervention to prevent postnatal depression, there was little evidence of effectiveness. Of 20 reviewed trials aiming to treat PND, there were encouraging outcomes, but many of the studies had methodological or reporting limitations. Of all the trials reviewed, The PoNDER Trial, a pragmatic cluster randomised trial (commissioned and funded by the NHS R&D Health Technology Assessment programme) was the largest, with the longest follow-up (to 18 months). This trial reported the cost-effectiveness of Health Visitors' role in the detection of PND and offering a psychological intervention. Among all the trials reviewed here, The PoNDER Trial has provided evidence of the cost-effectiveness of the HVs role in detecting PND and offering a psychological intervention.
To explore the views and experiences of nursing staff and patients about using hip protectors in in-patient clinical wards. Qualitative, cross-sectional study. Semi-structured interviews and focus groups were carried out with nurses and patients. All data were analysed using the 'Framework' method. Two dementia and two enduring mental health problem wards within an NHS Trust. Nurses (n = 22) and patients (n = 16). Patients and staff supported the use of hip protectors, because they: (1) were perceived to reduce falls-related injuries, (2) lessen anxiety around falls, and (3) provide patients with confidence to mobilise unaided. However, there was concern that hip protectors can reduce patients' ability to dress and use the toilet unaided. Some patients find protectors uncomfortable and hot, particularly in bed. Nurses in dementia wards reported that patients forget they are wearing the intervention, and that patients remove the protector once it is in position. The successful utilisation of hip protectors is dependent on: (1) the degree to which patients accept the purpose of the protector and any resultant discomfort and adverse impact on their independence; and (2) the ability of nursing staff to explain the benefits of the intervention, and to monitor its correct usage.
Postnatal depression currently represents the most frequent post-delivery pathology in Western countries. Early screening strategies constitute epidemiological challenges. Non-psychiatric staff must be offered adequate training on why, where, when and what kind of screenings must be established in order to obtain an effective reduction of postnatal depression. Perinatal psychiatrists should be encouraged to be meticulous about evaluation and availability of such screenings.
There is clear evidence for the effectiveness of specific interventions for common mental health problems in primary care. A major challenge is the inflexibility of traditional approaches to respond to the sheer volume of need. Evidence for brief cognitive behavioural therapy (CBT) based guided self-help interventions is emergent and may offer a way forward in responding to the issues of volume and accessibility. We present, an evaluation of a training course designed to equip non CBT trained workers to deliver such interventions. Seventeen primary care mental health workers participated in a 10-day training course focussed on CBT based facilitated self-help approaches. Evaluation focussed on knowledge of CBT; acceptability/usefulness of the training; self perceived incorporation into participants’ clinical practice and perceived barriers to the use of the knowledge and skills acquired. Measures were administered pre and post training and 6 months later. Positive changes were recorded in knowledge, self rating of use of CBT techniques, usefulness of training which largly maintained 6 months after the course concluded. Perceived barriers to implementation of the intervention were noted particularly in the institutional domain and remained up to 6 months post the course. In this group of staff the training outlined was able to produce desired changes that were maintained. The degree to which these changes were responsible for improved access or effectiveness is beyond the scope of this paper. Further research is recommended in relation to the optimum level of training required to deliver effective brief interventions as part of a stepped system of mental health care.
