Assessing and responding to anxiety and panic in the Emergency Department.

Anxiety and panic symptoms are widespread in the general population. The physical manifestations of anxiety and panic commonly account for people presenting to Emergency Departments (EDs). It is therefore important for ED clinicians to be informed of the numerous causes of anxiety and panic and equipped to respond effectively. This paper describes the underlying pathophysiology of the physical symptoms of anxiety and panic and differential diagnoses to consider. Organic conditions that are associated with symptoms of anxiety and panic are highlighted. Brief interventions are tabled for ED clinicians to use when explaining symptoms, and to promote individual self-management.

Exploring the meaning and practice of self-care among palliative care nurses and doctors: a qualitative study.

BACKGROUND: Self-care practice within the palliative care workforce is often discussed, yet seemingly under-researched. While palliative care professionals are required to implement and maintain effective self-care strategies, there appears little evidence to guide them. Moreover, there is an apparent need to clarify the meaning of self-care in palliative care practice. This paper reports qualitative findings within the context of a broader mixed-methods study. The aim of the present study was to explore the meaning and practice of self-care as described by palliative care nurses and doctors. METHODS: A purposive sample of 24 palliative care nurses and doctors across Australia participated in semi-structured, in-depth interviews. Interviews were digitally recorded and transcribed prior to inductive qualitative content analysis, supported by QSR NVivo data management software. RESULTS: Three overarching themes emerged from the analysis: (1) A proactive and holistic approach to promoting personal health and wellbeing to support professional care of others; (2) Personalised self-care strategies within professional and non-professional contexts; and (3) Barriers and enablers to self-care practice. CONCLUSIONS: The findings of this study provide a detailed account of the context and complexity of effective self-care practice previously lacking in the literature. Self-care is a proactive, holistic, and personalised approach to the promotion of health and wellbeing through a variety of strategies, in both personal and professional settings, to enhance capacity for compassionate care of patients and their families. This research adds an important qualitative perspective and serves to advance knowledge of both the context and effective practice of self-care in the palliative care workforce.

Positioning mental health nursing practice within a positive health paradigm.

Mental health service provision has traditionally been dominated by biomedical models of illness and disorder, a problem-based orientation, and the assessment and management of risk. While psychotherapeutic approaches are numerous and have been widely utilized, psychotropic medications, either as monotherapy or in conjunction with psychological therapies, remain the mainstay for the 'treatment' of mental health problems. This is despite growing uncertainty over the effectiveness of psychotropic medications (particularly antidepressants), as well as their potential for enduring and debilitating side-effects. This discussion paper outlines the emerging field of positive health, which eschews a psychiatric disorder and illness focus, and is instead oriented towards the identification of strengths, abilities, hopes, and the individual's preferred future. The shift in positive health, from illness towards wellness, aims to build health literacy and the capacity of individuals to make decisions conducive to health, and thereby make more effective the use of health-care services. A positioning of mental health nursing practice within a positive health paradigm is promoted. By illustration, a number of solution-focused mental health assessment questions are tabled to contrast the current format for mental health assessment, which rather than being 'comprehensive', is predominantly concerned only with problem and risk identification, and the search for pathology in the individual.

An emergency department-based mental health nurse practitioner outpatient service: part 2, staff evaluation.

The nurse practitioner role incorporates enhancing access to health-care services, particularly for populations that are underserved. This entails working collaboratively with colleagues across multidisciplinary teams and emphasizing a nursing model of practice within the nurse practitioner role. In Australia, the added value associated with establishing mental health nurse practitioner (MHNP) positions based in the emergency department (ED) is emerging. This paper presents qualitative findings from a study using a mixed-method design to evaluate an ED-based MHNP outpatient service in Sydney, Australia. One component of the evaluation involved semistructured interviews conducted with a random selection of study participants and a stratified sample of ED staff. This is the second of a two-part paper that presents an analysis of the qualitative data derived from the staff interviews (n = 20). Emergency staff were very supportive of the outpatient service, and perceived that it enhanced overall service provision and improved outcomes for patients. Moreover, staff expressed interest in receiving more formal feedback on the outcomes of the service. Staff also felt that service provision would be enhanced through additional mental health liaison nurses working in the department, especially after hours. An ED-based MHNP outpatient service expedites access to follow up to individuals with a broad range of problems, and supports ED staff in the provision of safe, effective, and more holistic care.