Motivational interviewing to enhance treatment attendance in mental health settings: A systematic review and meta-analysis.

WHAT IS KNOWN ON THE SUBJECT?: Despite differences between samples, some literature reviews have suggested that MI is effective in enhancing treatment attendance for individuals with mental health issues. Little is known regarding the effects of MI as a pre-treatment on individuals who are not seeking treatment for mental health issues. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review of the literature and meta-analysis demonstrates that MI is most beneficial for individuals who are not seeking mental health treatment. MI represents an opportunity for health promotion when patients are unmotivated but may otherwise be amenable to an intervention. MI is effective as a pre-treatment intervention to motivate individuals to attend further post-MI treatment and counselling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MI is a process and a useful tool for clinicians in all therapeutic interactions, to motivate their patients to seek further assistance for mental heath issues. Health promotion and encouragement to attend further treatment sessions can be facilitated through telephone contact. ABSTRACT: Introduction The stages of change model suggests that individuals seeking treatment are in the "preparation" or the "action" stage of change, which is the desired outcome of successful Motivational Interviewing (MI) interventions. MI is known to enhance treatment attendance among individuals with mental health problems. Aim This study examined the published research on MI as a pre-treatment to enhance attendance among individuals treatment-seeking and non-treatment-seeking for mental health issues. Methods Fourteen randomized controlled trials were identified, and MI efficacy was examined dichotomously: attendance or non-attendance for post-MI therapy. Subgroup analysis investigated treatment-seeking and non-treatment-seeking groups. Results Despite wide variations in sample sizes, blinding and monitoring, intervention fidelity was absent in the majority of published studies. Meta-analysis revealed that MI pre-treatment improved attendance relative to comparison groups. Conclusions Individuals not seeking treatment for mental health issues benefited the most from MI. Despite differences in MI treatment intensity, short interventions were as effective as longer interventions, whereas two MI sessions for as little as 15 min were effective in enhancing treatment attendance. Implications for Practice Motivational interviewing is a useful tool for clinicians in all therapeutic interactions to help motivate patients to seek assistance for mental health issues.

Critical care nursing organizations and activities: a fourth worldwide review.

AIM: To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns. BACKGROUND: This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009. METHODS: An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level. RESULTS: Fifty-nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes. CONCLUSIONS: Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action.

Survey of an Australian general emergency department: estimated prevalence of mental health disorders.

ACCESSIBLE SUMMARY: Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health-care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group represents a disproportionately large number of emergency department attendees. The study results indicate that around a third of people who attended the emergency department may have had a mental health disorder, which is more than that found in the general adult Australian population. The results also suggest that the majority of emergency department attendees that have a mental health disorder are not identified at this opportunistic point of contact. The emergency department is an ideal point of contact to screen people for mental health problems. If problems are identified early, and treatment is started early, then it is likely that more people would be helped before their mental health problem became severe. However, increased identification of mental health problems may have implications for mental health services in terms of workload and delivery. The aim of this study was to estimate the prevalence of mental health disorders in an Australian general emergency department. A cross-sectional survey was used to screen a sample of 708 patients, using the Kessler Psychological Distress Scale (K10). The mean age of participants was 50.2 years, and their mean K10 score was 19.96 (SD 7.83), with 24% categorized as having high or very high psychological distress. Seventeen per cent self-reported having a mental health issue. Post-probability calculations based on observed K10 scores estimated that 37% of participants had an actual mental health disorder. The results suggest the prevalence of mental health disorder is significantly higher in emergency department attendees than Australian population norms, supporting the contention that a substantial proportion of ED attendees has a mental health disorder that, in the majority of cases, is not investigated at this point of contact. There is potential to screen all emergency department attendees for the presence of mental health disorder; early identification of mental illness would enable early referral for treatment. However, if all patients are screened, then it is likely that more mental health conditions will be picked up. The implications for mental health nursing are that this may increase workload.

Critical care nursing organizations and activities--a second worldwide review.

BACKGROUND: This study is the second world survey of critical care nursing organizations (CCNOs). The first survey was undertaken 6 years ago and data were collected from 23 countries over a 2-year period. The aim of the second survey was to profile the issues and activities of critical care nurses and their professional organizations, expanding on the previous survey to obtain both an update of the issues and a wider global perspective. METHODS: A descriptive survey was emailed to 80 potential responding countries with recognized CCNOs or nursing leaders. Responses were analysed descriptively by geographical region. RESULTS: A total of 51 respondents completed the questionnaire over a 6-month period, achieving a return rate of 64%. The most common issues identified by critical care nurses were staffing levels and teamwork. Other important issues included wages, working conditions and access to quality educational programmes. The respondents perceived national conferences, professional representation, standards for educational courses, provision of a website, and educational workshops and forums as the five most important activities that should be provided for critical care nurses by national CCNOs. CONCLUSIONS: Workforce and education issues remain dominant themes among critical care nurses of the world. These issues have changed very little in the last 6 years. Using the World Federation of Critical Care Nurses network of regional CCNOs and critical care nursing leaders has proven to be a successful strategy for the collection of data on world issues and for international communication and support.

Paediatric critical care nurses' attitudes and experiences of parental presence during cardiopulmonary resuscitation: a European survey.

BACKGROUND: Although recent resuscitation guidelines are supportive of family presence during cardiopulmonary resuscitation literature from the last decade suggests that it is often discouraged, and the subject remains a controversial issue. OBJECTIVES: To determine the experiences and attitudes of European paediatric critical care nurses about parental presence during the resuscitation of a child. DESIGN: A survey design was employed. PARTICIPANTS: A convenience sample of European paediatric critical care nurses was used. METHODS: A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a 5-point Likert scale. Differences in attitudes were explored in three areas: decision-making, processes and outcomes of resuscitation. RESULTS: The results from this survey suggest that European paediatric nurses are very supportive of parental presence during cardiopulmonary resuscitation. Only a few nurses reported that their unit had a policy that covered parental presence during cardiopulmonary resuscitation and most nurses did not support the use of a dedicated nurse to look after the parents during resuscitation. CONCLUSIONS: Compared with previous studies relating to adult cardiopulmonary resuscitation, paediatric nurses experience family member presence more frequently than adult critical care nurses and appear to be more supportive of relatives' presence. It is recommended that paediatric intensive care units establish local policies that cover parental presence during cardiopulmonary resuscitation.

A European survey of critical care nurses' attitudes and experiences of having family members present during cardiopulmonary resuscitation.

This paper presents the results of a survey into the experiences and attitudes of 124 European critical care nurses to the presence of family members during cardiopulmonary resuscitation (CPR). Nurses from mainland Europe were less experienced and less sure about the consequences of relatives witnessing resuscitation than United Kingdom (UK) nurses. Generally, nurses supported the presence of family members, although UK nurses held significantly more positive attitudes than their non-UK counterparts in the areas of decision-making, processes and outcomes of resuscitation. Differences in attitudes are explored in the discussion. On the basis of results from this study, it is recommended that further policy guidance is required.

Worldwide overview of critical care nursing organizations and their activities.

While critical care has been a specialty within nursing for almost 50 years, with many countries having professional organizations representing these nurses, it is only recently that the formation of an international society has been considered. A three-phased study was planned: the aim of the first phase was to identify critical care organizations worldwide; the aim of the second was to describe the characteristics of these organizations, including their issues and activities; and the aim of the third was to plan for an international society, if international support was evident. In the first phase, contacts in 44 countries were identified using a number of strategies. In the second phase, 24 (55%) countries responded to a survey about their organizations. Common issues for critical care nurses were identified, including concerns over staffing levels, working conditions, educational programme standards and wages. Critical care nursing organizations were generally favourable towards the notion of establishing a World Federation of their respective societies. Some of the important issues that will need to be addressed in the lead up to the formation of such a federation are now being considered.

Health care support workers in the critical care setting.

The 1999/2000 winter demands on the NHS have once again highlighted deficits in UK critical care provision (Daily Telegraph, 2000; London Evening Standard, 2000) Recent years have seen the development of the role of health care support workers in the NHS; some critical care units now employ health care support workers This research examined the views of critical care unit staff on the introduction of health care support workers into the critical care unit It is concluded that the role is viable within the setting of this study A framework is outlined that could form the basis for a critical care health care support worker training programme

Fit for practice: Project 2000 student nurses' views on how well the curriculum prepares them for clinical practice.

This paper presents the findings from a small study, which compared student nurses' views on how well they felt the Project 2000 curriculum had prepared them for their first clinical placements. The views of two student nurse cohorts were obtained using a questionnaire developed for the purpose. The curriculum for the 'old' cohort allowed very little clinical time during the first 18 months and focused on academic classroom-based learning. The curriculum was subsequently restructured so that students on the 'new' curriculum experienced greater emphasis on practice and theory to practice links, and undertook their first clinical placement much earlier on in their course. Although statistical analysis of difference between the two cohorts suggests that students from the 'new' cohort felt they were better prepared, the actual differences in scores was small. The findings of this study provide only modest evidence of improvement in 'new' student nurses' views of how well they felt they had been prepared for their first placement.

Exploring the expanded role of nurses in critical care.

This paper reports on a small research study that explored the perceptions of staff in an intensive/coronary/high-dependency care unit on the expanded role of nurses in critical care. The research was undertaken in two phases. In the first phase, focus groups and interviews of nursing and medical staff were used as methods to explore their perceptions. Data were analysed by thematic content analysis and generated four categories: specialized skills; maintaining competence; how far nurses can go; and training and education. Using verbatim examples from the participants, these categories are described. In summary, it was found that both doctors and nurses were in favour of nursing role developments, and for the nurses this was driven by their desire to meet the patients' needs. In a smaller second phase, a questionnaire was developed based on information gained in the first phase. It was utilized to seek the views of all the nursing staff on specific role-expansion activities. Findings revealed substantial support for developing the role of critical care nurses in a number of activities: cannulation; venepuncture; ordering blood tests and X-rays; performing physiotherapy; inserting arterial lines; performing elective cardioversion; thrombolysis treatment and intubation. This research study has yielded important information. However, it is recognized that, whilst these roles may be new to this particular critical care unit, there are many other units where they may already be common practice. Whenever new roles are developed, it is important to evaluate their effectiveness in measurable terms and regular audit is advisable. Further research is therefore recommended on both the development and evaluation of new roles in critical care.

The role of the nurse in the paediatric out-patient department.

The aim of the study was to describe the role and function of the paediatric nurse in a POPD. The work of the three RSCNs and one HCSW employed in the department, was examined. 60% of the work undertaken in the department could be described as 'non-nursing'. The implications of this study are discussed in relation the department involved in the study, and generally in terms of potential development for POPDs.

Measuring the outcome of paediatric intensive care.

This paper describes the background to the publication of the paediatric intensive care framework (NHS Executive 1997a) and sets out the case for outcome assessment of paediatric intensive care. Issues relating to mortality and morbidity assessment are discussed and several assessment tools are outlined. It is proposed that functional and psychological outcome assessments are important indicators of the quality of health care provision.

On the receiving end: experiences of being a relative in critical care. Part 1.

This is the first of a series of three papers, presenting in her own words the experiences of Jane, an intensive care staff nurse, when her husband was admitted to her own intensive care unit. In part one, Jane describes her husband's admission to the accident and emergency department, the intensive care unit and subsequent transfer to a regional neurological unit. Jane gives a powerful and often very moving account of her experiences as a relative on the receiving end of critical care. There are many aspects of her husband's nursing and medical care, with which Jane remains dissatisfied. Some of these issues are discussed through professional commentaries, which are offered in the latter part of the paper.

Core body temperature measurement: a comparison of axilla, tympanic membrane and pulmonary artery blood temperature.

This research study was undertaken to examine the relationship between pulmonary artery blood temperature (regarded as the 'gold standard' measurement for core body temperature), axilla temperature using the Tempa.DOT Ax chemical thermometer and tympanic membrane temperature using the Diatek 9000 InstaTemp thermometer. Sixty adult intensive care patients had their temperatures monitored. A single set of five simultaneous temperatures, i.e. left and right axilla, left and right tympanic membrane (TM), and pulmonary artery (PA) blood were recorded. The mean difference between left and right TM temperatures was 0.58 degree C, and although both were moderately well correlated with PA temperature (r = 0.63 and 0.78, respectively) the mean differences between the two sites were clinically significant (0.85 degree C and 0.94 degree C, respectively). The range of differences between the sites was significant. Plotting limits of agreement showed that both left and right TM temperatures may be up to 1.2 degrees C above or 1.3 degrees C below PA blood temperature: a clinically unacceptable range. In particular, large temperature differences were recorded when patients were lying with one side of their head to a pillow. Fan therapy directed to the head was not found to affect these differences significantly. The mean difference between left and right axilla temperatures was 0.36 degree C, and although both were modestly correlated with PA temperature (r = 0.48 and 0.53, respectively) the mean differences between the two sites were clinically significant (0.47 degree C and 0.50 degree C, respectively). The range of differences between the sites was particularly significant. Plotting limits of agreement showed that both left and right axilla temperatures may be up to 1.2 degrees C above or 1.6 degrees C below PA blood temperature: a clinically unacceptable range. Because the range of temperature differences found between PA blood and the other sites was so great, it is concluded that neither the chemical axilla thermometer nor the tympanic membrane thermometer used in this study are clinically reliable tools for adult intensive care patients.

The care of critically ill children in adult ICUs: the way forward.

It is unlikely that in the short or medium term the PIC service can be restructured to such an extent that no children would need to be admitted to an adult ICU. Until this is the case the contribution of adult ICUs to the provision of PIC should be acknowledged and formally recognised as part of the service. Furthermore, there should be active support for these units from major/regional centres. There are clearly only a few adult ICUs which admit significant numbers of children. However, a more detailed analysis of adult ICUs is required to identify units which have available the full range of facilities, support services and appropriate staff to care for critically ill children. It is likely that only a few adult ICUs could meet the recommendations above, and it is in these units where efforts need to be concentrated. It is imperative that any nationally agreed standards or guidelines for PIC must apply equally to both adult ICU and paediatric ICU.

Advanced practice: do we know what it is?

The UKCC has proposed the development of an advanced practitioner role. The role is equated with master's and doctorate level of preparation. The development of the advanced practitioner role is outlined. The assumption that the nursing profession understands the term advanced practice is challenged. It is not possible to make explicit the role of the advanced practitioner unless nursing knowledge is used as its foundation. Two basic questions have yet to be answered: What is advanced practice? What is an advanced practitioner?

Assessing mental competence of patients and relatives.

This paper presents a discussion on the assessment of mental competence of patients and relatives in the health care setting. Their decision-making ability is explored with particular reference to the giving of consent for nursing intervention and medical treatment. It is suggested that, in addition to obvious psychological or neurological disorders, decision-making ability will be influenced by psychological stress and the ability to communicate effectively. It highlights the ambiguity of mental competence assessment and concludes that such assessments will, to a greater or lesser extent, be subject to value-laden judgement.

Core temperature measurement: a comparison of rectal, axillary and pulmonary artery blood temperature.

This research study was undertaken to determine the relationship between pulmonary artery (PA) blood temperature, rectal temperature and axillary temperature for adult patients admitted to an intensive care unit (ICU). 31 adults had their temperatures monitored. Simultaneous recordings of PA blood temperature, rectal temperature and axillary temperature were taken every 4h for up to 7 days. The mean difference between rectal and axillary temperature for all 31 patients was 0.32 degree C. Of the 16 patients who had their PA blood temperature monitored mean rectal temperature was 0.1 degree C above PA blood temperature and mean axillary temperature was 0.19 degree C below PA blood temperature. Very high statistical correlations were obtained which demonstrate the strength of the relationships between the three sites (rectal-axillary temperature difference R = 0.97; PA blood-rectal temperature difference R = 0.99; PA blood-axilla temperature difference R = 0.97). The linear relationship between the three sites studied was not found to be affected by age, gender, number of temperature samples taken, post/non-operative admission or peripheral temperature.