Nursing assessment of mental health issues in the general clinical environment: A descriptive study.

AIMS: To evaluate the effectiveness of a mental health screening form for early identification and care escalation of mental health issues in general settings. A secondary aim was to explore general nurses' use of the form and their confidence to discuss mental health issues with patients. METHODS: A cross-sectional design comprising a review of clinical records to determine use of the form, instances of missed care and escalation to the mental health team. The survey focused on nurses' confidence in general settings to engage in discussions with patients about mental health. Data were collected from April to December 2022. The Strengthening the Reporting of Observational Studies in Epidemiology Statement guided this study. RESULTS: Of 400 patient records, 397 were analysed; 293 (73.8%) of those had mental health screening by nurses. Age was a significant factor, with younger patients more likely to be screened although concerns were typically recognized in older patients. Of the 20 patients identified with mental health concerns, 9 (45%) were referred for further evaluation by the Clinical Liaison Team. While nurses were proactive in assessing physical risks, assessing risk factors that required deeper conversations with patients, including psychiatric history, was lacking. The survey highlighted fewer than half of the respondents (46%, n = 10) felt competent to engage in discussions about mental health; however, most (59%, n = 13) knew when to seek a mental health referral. CONCLUSIONS: General nurses have a role in the early identification and referral of patients with mental health challenges. However, training is imperative to facilitate deeper patient interactions concerning mental health. Integrating mental health checks within general settings is crucial for early detection and intervention, aligning with global quality care standards. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: We received feedback that shaped the research protocol from a consumer representative.

Strategic workforce planning in health and social care - an international perspective: A scoping review.

Effective strategic workforce planning for integrated and co-ordinated health and social care is essential if future services are to be resourced such that skill mix, clinical practice and productivity meet population health and social care needs in timely, safe and accessible ways globally. This review presents international literature to illustrate how strategic workforce planning in health and social care has been undertaken around the world with examples of planning frameworks, models and modelling approaches. The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium, Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or methodologies to explain how strategic workforce planning (with at least a one-year horizon) in health and/or social care has been undertaken, yielding ultimately 101 included references. The supply/demand of a differentiated medical workforce was discussed in 25 references. Nursing and midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered workers were poorly represented as was the social care workforce. One reference considered planning for health and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable projections. Increasingly needs-based approaches were called for to better consider demography and epidemiological impacts. This review's findings advocate for whole-system needs-based approaches that consider the ecology of a co-produced health and social care workforce.

Scoping of advanced clinical practitioner role implementation using national job advertisements: Document analysis.

AIM: The aim of this study is to profile the contemporary advanced clinical practitioner (ACP) role through standardized document sets. DESIGN: Documentary analysis of job descriptions (JDs), person specification and advertisements. DATA SOURCES: England based jobs advertised on NHS jobs website from 22 January to 21 April 2021. RESULTS: A toatal of 143 trainee and qualified ACP roles were identified. A wide range of sectors and specialities were represented from across all English regions. The most common roles were urgent care, emergency medicine and primary care. Most qualified roles were agenda for change band 8A, although this did vary across specialities. Many roles were restricted to a small number of professions, notably nursing, physiotherapy and paramedic. Inconsistent role titles were noted. A lack of understanding of regulation across different professions was noted. CONCLUSION: The ACP role has become an accepted across healthcare providers in England. Implementation remains varied across specialities and organizations. Eligibility criteria may relate to professional bias. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: ACP roles are expanding but this may be at the detriment to advanced nursing posts. Inconsistency in role eligibility suggests some professional bias exists. IMPACT: This was scoping of ACP roles across England using job advertisements. ACP roles are common across sectors and specialities but eligibility varies. The research will have impact on those looking to recruit to ACP roles as well as those refining JDs. REPORTING METHOD: No EQUATOR guideline exists for document analysis. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. The research relates to organizational human resource information only.

Patient attitudes towards outpatient cervical ripening prior to induction of labour at an Australian tertiary hospital.

A prospective patient questionnaire was conducted to assess attitudes and opinions towards outpatient cervical ripening in women attending an Australian tertiary hospital's labour and birth suite for a booked induction of labour. Questionnaires were distributed over a three-month period and information collected included demographic data, pregnancy and obstetric history, attitudes towards cervical ripening and willingness to undergo cervical ripening in the outpatient setting. Responses to 57 completed questionnaires were analysed. Forty-one patients (72%) underwent cervical ripening with Foley Catheter Balloon (FCB) only, eight (14%) with FCB and vaginal prostaglandins (VP), two (3.5%) with VP only and six patients (10.5%) did not require cervical ripening. One-third (33%) of patients stated, both before the commencement of cervical ripening and after delivery, that they would feel happy to undergo outpatient cervical ripening. Patient acceptance of outpatient cervical ripening has potential economic and psychosocial benefits for the healthcare system and patient respectively.

Spontaneous Uterine Rupture in a Preterm Pregnancy following Myomectomy.

A 44-year-old nulliparous woman was transferred to a tertiary obstetric hospital for investigation of acute onset abdominal pain. She was at gestation of 32 weeks and 2 days with a history of previous laparoscopic fundal myomectomy. An initial bedside ultrasound demonstrated oligohydramnios. Following an episode of increased pain early the following morning, a formal ultrasound diagnosed a uterine rupture with the fetal arm extending through a uterine rent. An uncomplicated classical caesarean section was performed and the neonate was delivered in good condition but with a bruised and oedematous right arm. The neonate was transferred to the Special Care Nursery for neonatal care. The patient had an uncomplicated postoperative course and was discharged home three days following delivery. This is an unusual presentation of uterine rupture following myomectomy where the fetal arm had protruded through the uterine wall.

The effects of experience on the inter-reliability of osteopaths to detect changes in posterior superior iliac spine levels using a hidden heel wedge.

BACKGROUND: The use of palpation to diagnose musculoskeletal dysfunction is commonly taught within osteopathy and other manual therapies. However the clinical tests used to detect sacroiliac joint dysfunction have not shown good reliability. OBJECTIVES: To investigate the inter-examiner reliability of osteopaths to detect asymmetries of the posterior superior iliac spine (PSIS), and to determine if inter-examiner reliability was affected by the level of practitioner experience. METHODS: Fifteen final year osteopathic students (n = 15), fifteen third year osteopathic students (n = 15) and ten experienced osteopaths (n = 10) manually palpated the levels of the PSIS in one model nine consecutive times. A hidden 5 mm heel wedge was used to alter the height of the PSIS which was hidden from the examiners. Scores were analysed using Fleiss Kappa (Fκ) statistics and one way analysis of variance on ranks (ANOVA). RESULTS: All three groups produced Fκ results below 0.4 (0.025-0.065), indicating poor inter-examiner reliability. Fκ values less than 0.4 are considered to be clinically unreliable. ANOVA testing did not show any significant difference between groups. CONCLUSION: This study showed 'poor' inter-examiner reliability in detecting asymmetries of the PSIS. This is in accordance with other studies in the field. It is suggested that the inclusion of this osteopathic model within osteopathic education should be reviewed.