Survey of staff experiences of potential stigma during the COVID19 pandemic.

The impact of COVID-19 on everyone's lives has been significant. However, there is also another factor related to the well-being of healthcare workers (HCWs) and that is how they are perceived by the general public. The aim of this study is to provide insight into the scope of this potential problem and describe how HCWs perceive community views and if this influences provision of patient care. A paper-based survey was conducted within mental health wards and community services as well as medical and surgical wards of a large metropolitan hospital in Queensland. Exploratory Factor Analysis was used to explore the dimensionality of the HCW stigma scale from the staff survey. Confirmatory Factor Analysis was used to assess validity and reliability. A total of 545 staff (67.9% nursing, 6.6% medical, 14.7% Allied Health and 10.8% Administrative) completed the survey between June and July 2020. Exploratory Factor Analysis showed that five factors explained 55% of the variance and represent factors of (i) Alienation, (ii) Social isolation, (iii) Perceived workplace harmony, (iv) Perceived job demands, (v) Clinical self-efficacy. The survey displayed high internal reliability and discriminant validity was observed for all subscales. Australian HCW's reported feeling well supported at work and appreciated by society in general during the pandemic, possibly because Australian healthcare services were better prepared than those countries that first experienced COVID-19.

Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions.

BACKGROUND: The Safewards model is gaining increasing acceptance in the mental health field in Australia and overseas. One of the most important goals of inpatient psychiatric services is to provide a safe and therapeutic environment for both patients and staff. However, this goal can be difficult to achieve if staff-patient interaction is not conducive to preventing violence and aggression. OBJECTIVE: The purpose of this study was to explore nursing staff perceptions of the factors impacting on their capacity to establish Safewards in acute adult inpatient wards. DESIGN: This study was guided by a phenomenological approach to develop a rich understanding of staff perceptions using semi-structured interviews. SETTING AND SAMPLE: The setting was three acute mental health wards attached to general hospitals; one in a large provincial hospital and two in metropolitan hospitals in south-east Queensland. Interview participants were a purposive sample of fifteen registered nurses across each of the three wards. METHOD: Semi-structured interviews were conducted at 12 months post-implementation of Safewards. The study was underpinned by Michie's integrative framework of behaviour change that helped identify target areas in order to enhance successful implementation of this model. RESULTS: Content analysis of interview transcripts highlighted a range of factors including failure to address the difficulties encountered by some staff in engaging with Safewards interventions, lack of support from management, poor use of nurse educator time, the 'language' of Safewards, high acuity on the study wards, and staff and patient turnover. CONCLUSION: This study highlights some difficulties with implementing Safewards and maintaining fidelity of the Safewards interventions in busy acute inpatient wards. Although these findings are from a qualitative study consisting of only 15 staff, our results indicate that efforts to implement Safewards need to address challenges faced by staff in engaging with the interventions, ensure buy-in from management, ensure adequate training and support during implementation and review training materials to ensure they fit with the local (i.e. Australian) context. Safewards provides an opportunity for a change in attitudes and development of a more therapeutic ward environment.

Mental health services planning for G20 summit in Brisbane and assessment of impact.

OBJECTIVE: The objective of this study was to inform planning for similar events, our aim was to describe planning undertaken by Brisbane Mental Health Services for the 2014 G20 Summit and the impact of the Summit on service use. METHODS: We analysed routinely collected service data comparing presentations and discharges for the same time period in two consecutive years. RESULTS: While presentations to mental health services increased from the previous year across a five-month period (including the month of G20), the week of the G20 Summit showed little change. CONCLUSIONS: Our findings will be useful to other services that prepare for major events, such as G20. Our experience shows that, with detailed planning and extra resources, the G20 Summit passed without any major mental health incidents or major increase for mental health presentations.

Does an educational intervention improve the usefulness of the Health of the Nation Outcome Scales in an acute mental health setting?

The purpose of the current study was to measure the effect of an educational intervention on the Health of the Nation Outcome Scales (HoNOS) completion rates. Additionally, interrater reliability and accuracy amongst nurses completing the instrument was assessed. We used a pre- and post-intervention design with videoed vignettes providing the basis for the educational intervention. Mental health nurses were assessed four times: at baseline, immediately after the intervention, 1 week later and again, 2 months after the intervention. There was a non-statistical increase in the number of patients assessed on admission using the HoNOS from 12.5% to 22.6%. Interrater reliability was low and did not improve through the course of the study. Intraclass correlation coefficients ranged 0.41-0.48. Accuracy was poor when discrete scoring between 0-4 was analyzed but improved when scores were dichotomised to reflect a clinically significant cut-off of 2 or more. The intervention improved completion rates marginally but interrater reliability and accuracy were low and did not improve over the study period. Opportunities for improvement were identified.

Quality of life and depression following childbirth: impact of social support.

OBJECTIVE: to evaluate the impact of social support on postnatal depression and health-related quality of life. DESIGN: prospective cohort study. Data were collected at baseline and at six weeks post discharge using a postal survey. SETTING AND PARTICIPANTS: between August and December 2008, 320 women from a large tertiary hospital were recruited following the birth of their infant. MEASUREMENTS: Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale and World Health Organization Quality of Life assessment questionnaire. FINDINGS: of the 320 women recruited, 222 (69.4%) returned their six-week questionnaire. Women with low social support had significantly higher scores on the EPDS than women who reported adequate support (p = 0.007). There was also a significant effect of social support on health-related quality of life. Women with low family or partner support scored lower in all domains, with the greatest mean difference in the social health domain (p = 0.000). Of those scoring >10 on the EPDS, 75.5% had sought professional help. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women with low social support are more likely to report postnatal depression and lower quality of life than well-supported women. Careful assessment of a woman's level of support following the birth, particularly from her partner and family, may provide useful information for possible interventions.

Validation of the WHOQOL-BREF among women following childbirth.

BACKGROUND: There is increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instruments has been validated for use postnatally. AIM: To assess the psychometric properties of the 26-item WHOQOL-BREF (short version of the World Health Organization Quality of Life assessment) among women following childbirth. METHODS: Using a prospective cohort design, we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL-BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL-BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure. RESULTS: In all, 221 (69.1%) women returned their six-week questionnaire. All domains of the WHOQOL-BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed women and non-depressed women. P < or = 0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r > or = 0.45). The domain structure of the WHOQOL-BREF was also valid in this population of new mothers, with moderate-to-high correlation between individual items and the domain structure to which the items were originally assigned. CONCLUSION: The WHOQOL-BRF is a well-accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies.

Contemporary management of aggression in an inner city mental health service.

OBJECTIVES: From 2002 to mid 2003, Royal Brisbane and Women's Hospital Mental Health experienced increased patient - staff aggression and staff injury which resulted in staff conflict and recruitment difficulties. Strategies introduced to reduce the frequency and impact of aggression in the mental health service were evaluated. METHOD: By mid 2003, incident data indicated increasing aggressive incidents. Based on this, an aggression management strategy was developed which included improved staff communication, new acute pharmacological treatment protocols, mandatory staff aggression management training, personal alarms and aggression risk assessment tools. RESULTS: Following the introduction of the strategy in early 2004, there was a reduction of 40% in aggressive incidents and a 56% reduction in staff injuries in 2005 compared to 2003 levels. A more assertive approach to tranquillisation was not associated with an increased adverse event rate for patients. CONCLUSIONS: A co-ordinated strategy can contain and reduce aggressive incidents in acute inpatient mental health settings. These strategies are transferable to other health settings including Emergency Departments.

Do clinical pathways really improve clinical performance in mental health settings?

OBJECTIVE: Royal Brisbane and Women's Hospital (RBWH) Mental Health developed and trialled two clinical pathways on psychosis and depression between 2001 and 2003 with the aim of improving a range of clinical and financial parameters. There was a strong commitment from senior management, appropriate resources were allocated and there was adequate staff support. Following a 6-month trial, the pathways were reworked extensively and combined into an acute inpatient pathway. From October 2003 to 2004, we trialled the acute inpatient clinical pathway, and monitored clinical and financial parameters. CONCLUSION: Over this 12-month period, the acute inpatient clinical pathway failed to demonstrate improvement on a range of clinical and financial parameters and its use was ceased. This trial lends support to the view that the complexity, individuality and variability of mental disorders means that clinical pathways are not beneficial in mental health settings.

Development of Australia's first psychiatric emergency centre.

OBJECTIVES: To describe the development of the first Australian psychiatric emergency centre co-located with the Emergency Department at the Royal Brisbane and Women's Hospital. This paper covers the current operational model, significant partnerships and benefits of this service, which assesses and treats over 7200 presentations per year. CONCLUSIONS: The co-location of the Psychiatric Emergency Centre and Emergency Department has created a unique model of service delivery and effective working relationships between the two services. The model improves clinical care providing multiple benefits for patients and the Emergency Department by means of direct access to specialized mental health staff, early mental health responsibility for patients and reduced access block.

A tale of three pathways: the experience of RBWH Mental Health.

OBJECTIVES: Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented. CONCLUSIONS: Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.