Mixed methods evaluation research for a mental health screening and referral clinical pathway.

RATIONALE: This study is an exemplar of mixed method evaluation research for development of a clinical pathway. AIM: To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans' Affairs-funded community nursing care of war veterans and war widows in the Australian context. METHODS: Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team. RESULTS: The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines. IMPLICATIONS FOR PRACTICE: The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors. CONCLUSIONS: This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate practical, evidence-based clinical pathways.

Action research informing the development of a conceptual model of care and service delivery to populations of interest in rural and remote communities.

OBJECTIVES: This paper aims to identify and respond to workplace stress and related issues in a rural community mental health team. METHOD: Action research (AR) underpinned this study and facilitated change in practice through four distinctive completed AR cycles with data analysis proceeding alongside data collection. Theories were articulated and explored and resulted in the development of a new model of praxis. CONCLUSIONS: A new model of praxis was developed which should contribute to both positive patient outcomes and improved staff occupational safety and wellness. Based on this, three clinical nursing tools were developed and implemented into practice.

An evaluation of a mental health screening and referral pathway for community nursing care: nurses' and general practitioners' perspectives.

AIMS AND OBJECTIVES: To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia. BACKGROUND: War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework. DESIGN: A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods--quantitative and qualitative. METHODS: Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey. RESULTS: Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses. CONCLUSIONS: Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties. RELEVANCE TO CLINICAL PRACTICE: The trialled pathway, which was modified and refined following the study, is an evidence-based resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

Preparing nurses with enhanced mental health knowledge and skill: a major in mental health.

In Australia, since the early 1990s there has been a significant change to the way in which mental illness has been managed. Major government reforms resulted in the 'mainstreaming' of mental health care, with a significant reduction in the numbers of psychiatric hospitals. This significant policy change resulted in the demise of direct entry, specialist mental health nurse education that was the main provider of the mental health workforce. In theory, since that time, nurses have been prepared for practice through a comprehensive degree program; however, there is strong evidence to suggest that the mental health content in the comprehensive program is well below what is needed for nurses to have the knowledge and skill to provide effective mental health care. This article reports on the development of an innovative curriculum designed to prepare an appropriately qualified nursing workforce with enhanced mental health knowledge and skill to be responsive to the changing nature of health service delivery.

Informing and implementing policy to advance mental health and wellbeing through action research in a rural remote community mental health setting.

OBJECTIVES: The aim of this study was to work collaboratively with a rural Community Mental Health Team (CMHT) to examine the issue of workplace stress and address issues specified by the group. METHOD: A five stage action research method following the Susman and Evered Model of Change was implemented for this research with four distinct cycles completed. RESULTS: A cyclic process of action research established that organizational policies, clinical skills and educational levels of staff were inadequate. Two overarching themes drove the research cycles: staff safety and inadequate education of nursing staff to assess and appropriately manage consumers with mental health issues. CONCLUSIONS: This study found that unsafe environmental conditions in the health workplace and limited staff knowledge contributed to workplace stress. Staff identified as vital strategies to manage aggressive or potentially aggressive incidents effectively and ensure staff and client safety. Managers, policy makers and government officials need awareness of the threats to healthy workforces. Tools to guide practice and staff education were implemented to address the identified problems.

The PACT Project: improving communication at handover.

OBJECTIVE: To describe and evaluate the PACT (Patient assessment, Assertive communication, Continuum of care, Teamwork with trust) Project, aimed at improving communication between hospital staff at handover. DESIGN, SETTING AND PARTICIPANTS: The PACT Project was conducted between April and December 2008 at a medium-sized private hospital in Victoria. Action research was used to implement and monitor the project, with seven nurses acting as a critical reference group. Two communication tools were developed to standardise and facilitate shift-to-shift and nurse-to-doctor communication. Both tools used SBAR (situation, background, assessment, recommendation) principles. All nurses attended workshops on assertive communication strategies and focused clinical assessment of the deteriorating patient. Questionnaires were distributed to nurses and doctors at baseline, and post-implementation questionnaires and qualitative data were collected from nurses immediately after the project. MAIN OUTCOME MEASURES: Nurses' opinions of improvement in structure and content of handover; nurses' confidence in their communication skills. RESULTS: At baseline, 85% of nurses believed communication needed improvement. After implementation, 68% of nurses believed handover had improved and 80% felt more confident when communicating with doctors. CONCLUSION: Early evidence supports the use of standardised communication tools for handover, together with specific training in assertive communication and patient assessment. Long-term evaluation of patient outcomes is needed.