Post-fall reporting in aged acute inpatient mental health units: an 18-month observational cohort study.

BACKGROUND: Despite the high risk of falling for people with severe mental illness, there is limited falls research in mental health settings. Therefore, the objective of this observational cohort study was to conduct a focused post-fall review of fall episodes within aged acute inpatient mental health units at one of Australia's largest publicly funded mental health organizations. METHODS: A post-fall reporting tool was developed to collect intrinsic and extrinsic fall risk factors among three aged acute mental health inpatient units over an 18-month period. Descriptive and inferential analyses were conducted to describe fall risk factors and predictors of fall risk. RESULTS: There were a total of 115 falls, of which the tool was used for 93 (80.9%) episodes. Falls occurred most often in consumer's bedroom/bathroom and were unwitnessed. Intrinsic risk factors were most often attributed to postural drop and losing balance during walking. However, that was in contrast to consumer's who self-reported feeling dizzy as the reason of the fall. CONCLUSIONS: Based on the cohort, future falls could be reduced by targeting those aged above 82 years, or with a diagnosis of dementia. Recurrent falls during admission could be reduced by targeting those with psychotic illness and males with a diagnosis of dementia. A clearer dialogue among consumers and clinical staff reporting about fall episodes may support future remedial interventions and inform programs to reduce fall risk and assist the challenge of describing unwitnessed falls in aged acute inpatient mental health settings.

Touching their lives: North Western Mental Health's approach to practice development in aged mental health.

The ongoing development of mental health practice is an important issue for consumers, carers, and clinicians. This paper outlines a practice development project undertaken by North Western Mental Health. The aim of the project was to assist nurses and direct care staff working in a residential facility to provide individualized, sensitive, therapeutic, and responsive care for long-term clients with severe mental illness. A clinical nurse educator was engaged to help facilitate changes to both attitudes and practices in a specialist environment catering to those with psychiatric, cognitive, and physical health concerns. The project identified institutionalized routines and practices that were entrenched within the setting and, with support and guidance from a clinical nurse educator, encouraged enhancement of clients' experience and choice. Nurses' clinical reasoning skills were also extended through this process. The project encouraged all staff to develop and maintain an awareness of residents' experience of receiving care in a potentially disempowering environment. In particular, nurses were challenged to consider how nursing, realized to its full potential, can touch the lives of residents and families.

Exploring the role of the mental health nurse in community mental health care for the aged.

There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.