Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation.

Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.

Self-management of type 1 diabetes in young adults: Is it impeded by aspects of everyday life? A scoping review.

BACKGROUND AND AIM: For people with type 1 diabetes, self-management is a necessity. However, self-management can be impeded by aspects of everyday life, which may impact young adults moving to independence. However, it is not yet clear which aspects are most relevant, nor what knowledge gaps remain. METHODS: An established scoping review methodology was used to select and synthesise the existing literature. Sixteen peer reviewed articles were included for analysis. RESULTS: Type 1 diabetes self-management exists within a disordered space, impeded by aspects of everyday life, while simultaneously impeding daily living. Negative attitudes, concealment, non-adherence, Diabetes Distress, and mental illness were each associated with difficulty in self-management. A cyclical relationship between these characteristics emerged: they are obstacles to self-management yet also result from poor self-management. Young adults were identified as a vulnerable demographic: they tend to perceive type 1 diabetes more negatively and have additional life priorities (e.g., education/work) that lead to suboptimal self-management, including non-adherence behaviours, which can reduce quality of life. Several gaps in the literature were found, notably around psychological experiences, employment, and effective interventions. Few studies involved in-depth exploration of lived experiences. CONCLUSIONS: There is a need to develop novel interventions to support self-management of type 1 diabetes that target the obstacles identified here. Furthermore, experiential research into younger adults' experiences of life and work with type 1 diabetes will help fill the knowledge gap for this demographic.

Considering skin-to-muscle depth for successful intramuscular injections in an increasingly obese population.

BACKGROUND: Intramuscular (IM) injection practice is an essential nursing skill. Current practice relies on clinical judgement to determine needle length (unless specified in the medicine's product licence). Obesity is increasing in the global population, but guidelines have largely ignored how to select needle length to meet individual patient need. AIM: The aim of this review was to systematically review the skin-to-muscle depth required to achieve injection into muscle in adults. The objectives were to identify any implications of obesity status when selecting an appropriate needle length and site in clinical practice. Search and review methodology: Studies of subjects above the age of 18 years using observational or experimental designs where the distance from the skin to muscle had been measured at any IM injection site, and obesity status was reported, were included in the search strategy. The primary outcome of interest was the distance from skin surface to muscle penetration. FINDINGS: 14 studies were identified that investigated the dorsogluteal, ventrogluteal, deltoid and vastus lateralis sites, all used cross-sectional observational designs. Ten used ultrasound, three used computed tomography (CT) and one used magnetic resonance imaging. Obesity status was reported as BMI or hip-to-waist ratio. In all studies there was a correlation between obesity status and the distance from skin surface to muscle. In females this exceeded 37 mm at both gluteal sites, independent of obesity status. CONCLUSIONS: There should be an assessment of obesity status before selecting needle length for IM injections in both genders. Needles longer than the standard 37 mm are recommended for all females, whatever their obesity status, for any gluteal site. Injections into gluteal sites should be avoided in females who are obese. Deltoid injections are more likely to achieve muscle penetration in both genders, and in patients who are overweight or obese. Further research is required.

An Evaluation of MINDFIT-A Student Therapeutic Running Group as a Multi-Layered Intervention in the United Kingdom.

BACKGROUND: Mental health is an ever-increasing concern for UK Universities and is underreported. Creative and dynamic approaches to tackle student wellbeing are important. In 2018, Sheffield Hallam University (SHU) Student Wellbeing Service initiated a pilot study of a therapeutic running programme 'MINDFIT' that combined physical activity, led by a counsellor, alongside a psychoeducation approach to support student mental health. METHODS: Mixed methods were used which included the Patient Health Questionnaire-9 (PHQ-9), evaluating low mood and depression, and Generalized Anxiety Disorder Scale-7 (GAD-7), evaluating levels of anxiety. RESULTS: A total of 28 students were triaged onto a weekly programme over three semesters. Overall, 86% of the participants completed the programme. A promising reduction in the scores for PHQ-9 and GAD-7 was found at the end of the programme. Focus groups, with student participants, were held to gather qualitative data for analysis. After thematic analysis, three main themes emerged: "Creating a safe community", "Making progress" and "Pathways to success". CONCLUSIONS: MINDFIT was an effective and engaging multi-layered therapeutic approach. Recommendations identified the importance and effectiveness of the triage process in recruiting students and sustainability of the programme through the continued engagement of students post programme. More research is required to identify the long-term effects of the MINDFIT approach and how applicable it is to higher education contexts.

Rapid upskilling about COVID-19 vaccines: an evaluation of a novel interprofessional education workshop.

BACKGROUND: An inter-professional education (IPE) workshop centred around newly approved COVID-19 vaccination was attended by 77 nursing and pharmacy students. AIM: To embed and evaluate the implementation of a virtual IPE workshop, and to upskill undergraduate nursing and pharmacy students about the COVID-19 vaccination. METHODS: The workshop was evaluated using a questionnaire completed by participants from both disciplines. A focus group was conducted with the IPE facilitators. RESULTS: 77 students out of a potential 400 attended the workshop (19% attendance). Of the 77 participants, 44 (23 nursing, 21 pharmacy) completed the questionnaire (57%), rating the content highly. There was overall positivity toward working interprofessionally, and there was no evidence of significant differences between how the two groups of students rated the workshop. Qualitative findings from students and facilitators corroborated the supposition that the workshop would enhance professional development. Thus, the workshop was successful in facilitating interprofessional interactions, with students all working collaboratively toward the same goal, the ultimate purpose of IPE. It was agreed that such an event should be included as part of the student curricula. CONCLUSION: Implementing an IPE event that includes real-time healthcare priorities can contribute to optimising students' healthcare education. More high-quality longitudinal research is needed to understand the impact of such sessions on students' competence and confidence.

Can interprofessional research enhance health care students' understanding and knowledge towards evidence based practice: A cross sectional study.

AIM: To explore how inter-professional collaboration in the teaching and learning of research skills prepares undergraduate students for their professional roles in healthcare via an evaluation of inter-professional research modules from the student perspective. PARTICIPANTS AND SETTINGS: Participants were selected from a university in the North of England where all undergraduate Healthcare students were taught Research and Evidence Based Practice (EBP) through interprofessional education (n = 400). METHODS: Quantitative data was collected using an adapted Attitudes Towards Interprofessional Education Scale and internally-designed pilot instruments. Qualitative data was also collected via open comment to evaluate the taught research module. RESULTS: 50 students completed the survey pre-module and 49 students completed the survey post-module. The participants' views towards inter-professional education (IPE) are generally positive: the median responses of 4 single-item measures assessing inter-professional learning on 7-point Likert scales were 5 or above (where higher scores represented more positive perceptions). Scores on the Attitudes towards Interprofessional Education scale also generally represented positive opinions, with a mean post-test score of 58.8 on a scale from 5 to 75, with higher scores indicating greater levels of positivity. No evidence for a statistically significant improvement from the pre- to post- 3rd year experience of the IPE/research theme was revealed. Qualitative data identified six themes: promoting team working, developing awareness of other health care professional's roles, polarising research and practice, multidisciplinary team (MDT) working or not working, logistical issues and developing research skills. CONCLUSIONS: This study raised questions about the appropriateness of "unnatural" pairings for undertaking research projects. Whilst the students valued working together in the research process, they do not appear to have perceived a universal benefit to their inter-professional clinical practice.

Service user and carer experiences of the advanced nurse practitioner role in a memory assessment team.

BACKGROUND: Advanced nurse practitioners (ANPs) within memory services can support prompt diagnoses of dementia. Further understanding of the role is necessary as evidence on its effectiveness is limited. AIM: To assess service user and carer satisfaction with the ANP role within Kirklees memory assessment team. METHODS: A cross-sectional survey was undertaken to evaluate carer and patient perceptions of the ANP role in a local memory assessment team. The survey was developed using the Royal College of Nursing's four pillars as a structure: clinical/direct care practice, leadership and collaborative practice, improving quality and developing practice, and developing self and others. RESULTS: One hundred and fifteen surveys were sent out, and 85 were completed, a response rate of 73.9%. Patients expressed significant satisfaction with the ANP, in particular in the areas of direct clinical practice (84%) and quality of care received (87%). CONCLUSION: Patients and families are highly satisfied with the service provided by the ANP. High-quality research is needed on the cost effectiveness and outcomes of ANP interventions.

Developing the advanced nurse practitioner role in a memory service.

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Developing the advanced nurse practitioner role in a memory service.

This article describes how one NHS trust in northern England developed the advanced nurse practitioner (ANP) role within its memory services. It discusses how ANP roles were developed and implemented across four localities of a large NHS trust that provides a number of locally based memory services to improve the diagnostic pathway for people referred to the service and their carers. Advanced practice is considered more broadly followed by a review of the literature related to the role of the ANP and non-medical prescriber in mental health and, more specifically, memory assessment and diagnostic services. Challenges to gaining the requisite competency to work as an ANP are discussed. The need for a clear agreed strategy to ensure practitioner competence and effective governance for the introduction of these roles is described. It is argued that using this model allowed for mental health nurses within memory services to make a major contribution to the transformation of such services and receive recognition for the expansion of their role and appropriate remuneration linked to national NHS employment role profiles. The potential benefit of the ANP role more broadly in mental health services is discussed, together with factors that may have previously hindered their contribution to the transformation of services. The strategic development and planning process that led to implementing the ANP role within memory services is presented, together with a description of how the relevant higher level clinical skills required for the roles were achieved and formally accredited.

Increasing the health literacy of learning disability and mental health nurses in physical care skills: a pre and post-test evaluation of a workshop on diabetes care.

This paper presents the pre- and post-test results of the outcomes of a workshop designed to increase learning disability and mental health nurses' knowledge and skill to undertake interventions for service users at risk of, or with a diagnosis of, type 2 diabetes. Health literacy is also discussed as a way of explaining why such nurses may lack expertise in physical health care. Findings from the workshop show that learning disability and mental health nurses have the motivation to increase their health literacy (skills and knowledge) in diabetes care. The potential of such workshops, and how organisations looking forward to the future can build health literacy, is discussed.

The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings.

The purpose of this study was to investigate perceptions of barriers to safe administration of medicines in mental health settings. A cross-sectional survey was used, and 70 mental health nurses and 41 students were recruited from a mental health trust and a university in Yorkshire, UK. Respondents completed a questionnaire comprising closed- and open-response questions. One item, which contained seven sub-items, addressed barriers to safe administration of medication. Seven themes--five nurse- and prescriber-focused and two service user-focused--were abstracted from the data, depicting a range of barriers to safe administration of medicines. Nurse- and prescriber-focused themes included environmental distractions, insufficient pharmacological knowledge, poorly written and incomplete medication documentation, inability to calculate medication dosage correctly, and work-related pressure. Service user-focused themes comprised poor adherence to medication regimens, and cultural and linguistic communication barriers with service users. Tackling medication administration error is predominantly an organizational rather than individual practitioner responsibility.

Training mental health nurses to assess the physical health needs of mental health service users: a pre- and post-test analysis.

PURPOSE: The aim of this project was to develop, deliver, and evaluate a brief evidenced-based education package to enhance physical health literacy in mental health nurses. DESIGN AND METHODS: Pre- and post-test survey of knowledge of physical health in serious mental illness, satisfaction with the workshop, and applicability to practice. FINDINGS: Participants were motivated to attend and complete the questions. There was statistically significant knowledge gain immediately post workshop and participants described satisfaction with the content and a willingness to apply learning from the session to their practice. PRACTICE IMPLICATIONS: If such workshops are provided as a collaborative and relatively inexpensive way of education, they can contribute to building the capacity of mental health nurses to be literate in physical health interventions.

Mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination to assess their competence in medicine administration.

The aim of this study was to evaluate mental health and learning disability nursing students' perceptions of the usefulness of the objective structured clinical examination (OSCE) in assessing their administration of medicine competence. Learning disability (n = 24) and mental health (n = 46) students from a single cohort were invited to evaluate their experience of the OSCE. A 10-item survey questionnaire was used, comprising open- and closed-response questions. Twelve (50%) learning disability and 32 (69.6%) mental health nursing students participated. The OSCE was rated highly compared to other theoretical assessments; it was also reported as clinically real and as a motivational learning strategy. However, it did not rate as well as clinical practice. Content analysis of written responses identified four themes: (i) benefits of the OSCE; (ii) suggestions to improve the OSCE; (iii) concern about the lack of clinical reality of the OSCE; and (iv) OSCE-induced stress. The themes, although repeating some of the positive statistical findings, showed that participants were critical of the university setting as a place to conduct clinical assessment, highlighted OSCE-related stress, and questioned the validity of the OSCE as a real-world assessment. The OSCE has an important role in the development of student nurses' administration of medicine skills. However, it might hinder their performance as a result of the stress of being assessed in a simulated environment.

Facilitating knowledge of mental health nurses to undertake physical health interventions: a pre-test/post-test evaluation.

AIM: The aim of this project was to develop and deliver an evidence-based educational package with a physical and mental health focus to clinicians and other health care workers in mental health settings. BACKGROUND: For individuals who experience mental disorders, pharmacotherapy is often considered as a first line of treatment. However, owing to adverse drug reactions and pre-existing physical conditions, outcomes for clients/service users may be compromised. Mortality and morbidity rates of people diagnosed with a serious mental illness caused by physical health conditions do not compare favourably with the general population. This paper reports on a physical skills project that was developed in collaboration between the University of Huddersfield and South West Yorkshire Partnership Foundation Trust. METHOD: Pre-post study design: five workshops were conducted in the fields of intramuscular injections, diabetes, health improvement, oral health and wound care. A total of 180 pairs of questionnaires to assess practitioner and student skills and knowledge were administered to participants before and after workshops. All workshops resulted in a statistically significant improvement in subject skills and knowledge scores (P < 0.001 in all cases). Questionnaires also elicited participant satisfaction with the workshops: over 99% of participants reported being 'satisfied' or 'very satisfied' with the workshops. IMPLICATIONS FOR NURSING MANAGEMENT: Mental health nurses are the largest group of registered practitioners working in the mental health setting and thus need to be harnessed to make a positive contribution to the improvement of the physical health status of service users with a serious mental illness.

Measuring the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner students in the United Kingdom.

PURPOSE: To evaluate the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner (ANP) students in primary care (family practice). DATA SOURCES: Three cohorts of ANPs who undertook a Mental Health Problems in Primary Care Module as part of their MSc ANP (primary care) run by the University of Huddersfield completed the Elsom Therapeutic Optimism Scale (ETOS), in a pre- and postformat. The ETOS is a 10-item, self-administered scale, which has been used to evaluate therapeutic optimism previously in mental health professionals. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: All three cohorts who completed the scale showed an improvement in their therapeutic optimism scores. With stigma having such a detrimental effect for people diagnosed with a mental health problem, ANPs who are more mental health literate facilitated by education and training in turn facilitates them to have the skills and confidence to engage and inspire hope for the person diagnosed with mental health problems.

Diabetes: increasing the knowledge base of mental health nurses.

Physical health assessment for people with a serious mental illness (SMI) has been a neglected issue, with all the evidence showing that mental health nurses (MHNs) and associated practitioners need to develop such skills. The University of Huddersfield and South West Yorkshire Partnership Foundation Trust collaborated in a Physical Skills Project with the aim of facilitating knowledge and skills for MHNs. The development of the education and training workshop is presented. The results of a pre- and post-test evaluation of diabetes, evaluation of the workshop and, finally, implications for practice with regard to transferable knowledge and skill, are discussed.

An evaluation of therapeutic optimism in advanced nurse practitioner students.

AIM: To measure the influence of a mental health training module on the therapeutic optimism of primary care advanced nurse practitioner (ANP) students. METHOD: A pre and post-test evaluation of the influence of a mental health training module on the therapeutic optimism of ANP sttudents in primary care was conducted. Students completed an adapted Elsom Therapeutic Optimism Scale (ETOS), before and after completing the module, and the ETOS scores were analysed. RESULTS: Therapeutic optimism scores were higher following module completion. CONCLUSION: Up to 70% of UK mental health presentations are assessed and managed in primary care. Many patients will be assessed, diagnosed and treated by ANPs. This evaluation shows that a marked increase in therapeutic optimism occurs after module completion.

Debating mental health nurses' role in medicines management.

This article delineates concordance and adherence; two fundamental positions pertaining to the role of the nurse in medicine management. Taking the form of a debate, it uses mental health nursing to describe the role and function of concordance and adherence in practice. Each author presents their case and responds briefly to the other in order to show why they see the adoption of one term or another as central to medicines interventions with the patient. The purpose of the paper is to encourage readers to consider their own position in relation to this important debate.

Implementing a competence framework for administering medication: reporting the experiences of mental health nurses and students in the UK.

Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.

The Medicine with Respect Project: a stakeholder focus group evaluation.

The administration of medicines is a role that fundamentally impacts on the wellbeing of the patient and has been described as one of the highest risk activities that a nurse undertakes. This article reports on the Medicine with Respect Project where collaborating organisations sought to improve the education and training of Mental Health Nurses toward safe and competence practice. Focus groups were used to evaluate stakeholders experiences and what emerged was overall satisfaction but with specific suggestions in how to improve the effectiveness of the project. All groups emphasised that all nurses in administering medicines should undergo a rigorous assessment of their medicines administration performance. This would make the ultimate aim of competent and safe practice more achievable.