Healthcare interventions for sex workers: protocol for a scoping review.

INTRODUCTION: Sex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured to facilitate engagement with sex workers and therefore, services are needed that are accessible to this population. The aim of this scoping review is to understand the evidence base for approaches, services and interventions that are aimed at addressing sex workers' health needs. METHODS AND ANALYSIS: Nine databases, CINAHL, Embase, EThOS, Google Scholar, Health Management Information Consortium, MEDLINE, ProQuest Dissertations and Theses, PsycINFO and Web of Science (Core Collection), will be searched, with results limited to English language publications and those published from 2003 onwards. De-duplication, study selection and data extraction will be conducted using Covidence software. Included studies will describe or evaluate approaches, services or interventions that address the health needs of sex workers who offer services that involve physical contact with a client. ETHICS AND DISSEMINATION: No ethical review is needed. The final report will be shared with Birmingham City Council as part of ongoing work and will be disseminated by peer-reviewed publication. STUDY REGISTRATION: Open Science Framework (doi: 10.17605/OSF.IO/N7WSX).

Mental health nurses' attitudes towards risk assessment: An integrative systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but some nurses see it as a 'tick the box' exercise. Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. WHAT THE ARTICLE ADDS TO EXISTING KNOWLEDGE?: Mental health nurses' attitudes towards risk assessment are diverse with regard to its legitimacy, conduct and value. This study provides an organised framework to help understand the areas in which these different attitudes occur. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. ABSTRACT: INTRODUCTION: Understanding nurses' attitudes towards risk assessment could inform education and practice improvements. AIM/QUESTION: To explore mental health nurses' attitudes towards risk assessment. METHOD: An integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis; quantitative data were integrated with emerging themes. RESULTS: Eighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation); use of structured approaches (technical orientation); value of intuition (intuitive orientation); and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses. DISCUSSION: Mental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment. IMPLICATIONS FOR PRACTICE: This review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes.

A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings.

INTRODUCTION: Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. METHODS: CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. RESULTS: Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. DISCUSSION: There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.

Child abuse in children living with special guardians, a service evaluation of child protection medical examinations.

Objective: To determine difference in frequency of referral for child protection medical examination (CPME) in children subject to special guardianship order (SGO), subject to child protection plan (CPP) or neither. Design: Service evaluation analysing data from CPME reports. Setting: Acute and community healthcare providers in Birmingham UK, during 2018. Patients: All children aged 0-18 years requiring CPME. Main outcome measures: Details were obtained from CPME reports on: age, SGO status, CPP status, reason for CPME, injuries sustained, presence of non-accidental injury.Population data were obtained from the local children's safeguarding board and national statistics. Results: Reports were available for 292/298 (98%) CPME, relating to 288 children. 5 children were subject to SGO, 39 were subject to CPP, none subject to both. Non-accidental injury was substantiated in 189/288 (66%). The child population was 288 000. 1665 children were subject to CPP and approximately 750 subject to SGO. The relative risk (RR) for children subject to SGO requiring a CPME compared with children not subject to SGO or CPP is 7.86, p<0.0001 with 95% CI (3.26 to 19.02). The RR for children subject to a CPP requiring CPME compared with children not subject to SGO or CPP is 27.65, p<0.0001 with 95% CI (19.78 to 38.63). Conclusions: This is a small study and findings need interpreting cautiously. Children subject to SGO may potentially be at higher risk of abuse than the general population despite living with carers who have passed social care parenting assessments. There is no register of children subject to SGO so professionals may be unable to offer families additional support. SGO families should be offered enhanced support and monitoring routinely. Children subject to CPP are not being adequately protected from further abuse.

Reducing health inequalities for people with serious mental illness.

People with serious mental illness (SMI) are at risk of dying many years earlier than the general population. Providing an effective, cost-efficient healthcare service requires a holistic approach, and improving the physical health of people with SMI should be integral to all healthcare roles. It is important for nurses to identify and understand the barriers that people with SMI may experience when accessing physical healthcare. A range of factors contribute to reduced life expectancy, including lifestyle factors, symptoms of mental illness and the side effects of medications. This article discusses four areas of health that commonly affect people with SMI: metabolic syndrome, smoking, oral health and sexual health. Metabolic syndrome is a cluster of risk factors that increase an individual's risk of cardiovascular disease, stroke and type 2 diabetes mellitus. Smoking is increasingly prevalent in people with SMI, with rates remaining steady despite a decline in smoking rates nationally. Oral health and sexual health can negatively affect the physical health and well-being of people with SMI; however, these aspects of health are often neglected. This article identifies ways that nurses in all practice settings can use health promotion, assessment and treatment to improve the physical health of people with SMI in relation to these four areas.

How to address the physical needs of clients in a mental health setting.

People with mental health illness, particularly those affected in the long-term, experience higher rates of morbidity and mortality than the general population. It is, therefore, crucial to meet their physical health needs as part of delivering a high quality service. This article reports on how nurses in a medium secure mental health unit used the 'plan, do, study, act' approach (Deming 1986) as a practice improvement tool to introduce a system of monitoring the physical health of service users.