Predictors of burden in Australian mental health caregivers: a cross-sectional survey.

BACKGROUND: The shift towards providing mental healthcare in the community has resulted in caregivers becoming more involved in the delivery of these services. Supporting mental health consumers can be burdensome which, in conjunction with the anguish that may result from observing their relative develop a mental illness, can lead to carers experiencing significant levels of distress. AIMS: This study aimed to quantify the extent to which specific aspects of caregiving contribute to mental health burden in Australia. METHODS: Participants were included if they were Australian mental health caregivers. An online questionnaire was distributed via email. Multivariate logistic regression was used to identify predictors of burden in mental health caregivers. RESULTS: Completed questionnaires were collected from 231 respondents. The logistic regression analysis yielded five factors that contributed significantly to mental health caregiver burden. Of these factors, a strained atmosphere and regularly carrying out tasks for consumers were the two strongest predictors of burden. CONCLUSION: Community health professionals could focus on interpersonal relationships between family members, access to disability and financial support services, and carers' views about the quality of healthcare provided to consumers. Addressing these issues may decrease carer burden and improve the quality of life for all family members.

Suicide risk and social support in Australian resource sector employees: A cross-sectional study.

This study examines the association between suicide risk and social support in Australian resource sector employees. We included 150 participants, who completed the Beck Hopelessness Scale and MOS-Social Support Survey. Data were analyzed using smallest space analysis and multidimensional scalogram analysis. The analysis identified four distinct regions, which were conceptualized as "confiding," "affection," "companionship," and "practical help." All of these components of social support were associated with hopelessness, which has important clinical implications as hopelessness is related to suicide risk. The results of this study also demonstrated that lower levels of social support, and greater sense of perceived hopelessness tended to lead to Australian resource workers seeking assistance from mental health professionals in the previous year. Attention should turn towards providing interventions that promote social support for employees in Australian resource industry.

The effect of self-selected complementary therapies on cancer patients' quality of life and symptom distress: A prospective cohort study in an integrative oncology setting.

OBJECTIVE: To examine the effectiveness of a multifaceted complementary therapies intervention, delivered in a systematic manner within an Australian public hospital setting, on quality of life and symptom distress outcomes for cancer patients. METHODS: Adults receiving treatment for any form of cancer were eligible to participate in this study. Self-referred participants were offered a course of six complementary therapy sessions. Measures were administered at baseline, and at the third and sixth visit. The primary outcomes were quality of life and symptom distress. Linear mixed models were used to assess change in the primary outcomes. RESULTS: In total, 1376 cancer patients participated in this study. The linear mixed models demonstrated that there were significant improvements in quality of life and significant reductions in symptom distress over six sessions. Body-based therapies demonstrated significantly superior improvement in quality of life over counselling, but no other differences between therapies were identified. Reduced symptom distress was not significantly associated with any particular type of therapy. CONCLUSION: A self-selected complementary therapies intervention, provided in an Australian public hospital by accredited therapists, for cancer patients significantly mproved quality of life and reduced symptom distress. The effect of this intervention on quality of life has particular salience, since cancer impacts on many areas of people's lives and impairs quality of life.

Mental Health Consumers' Motives for Seeking Advocacy Support: A Qualitative Exploration.

Advocacy plays a vital role in ensuring that mental health consumers' rights are maintained. However, the primary issues for which consumers seek advocacy support remain unknown. Understanding these issues provides a sound basis from which advocacy organisations may develop a clear service delivery focus. This study addresses the literature gap through presenting a qualitative analysis of 60 records from an advocacy service. Four major themes emerged, across which two key issues were dominant: the sense of fearfulness and disempowerment. These issues accentuate the importance of advocates in enhancing the agency of mental health consumers.

Structuring educational decisions using the multiple sorting task: An example focusing on international placements in nursing.

Practical examples of the steps involved in the planning and execution of the multiple sorting task are frequently lacking in published reports. This article demonstrates how the multiple sorting task can be used to structure conversations with a group of health professionals planning an international placement for nursing students. Sixteen participants were drawn from diverse professional backgrounds, including academia, clinical practice, government policy, and placement administrators. Participants sorted 17 statements written on cards into categories of their choice and noted why they sorted the cards into these particular groups. Data were analysed using multidimensional scaling and qualitative perspectives. The analysis identified four key themes that detailed the participants' views about international placements. These findings demonstrate how the multiple sorting task can be used to generate information that facilitates the examination of important facets of health care practice that universities could cover in preparing students for international placements.

Mental health nurses' views about antipsychotic medication side effects.

WHAT IS KNOWN ON THE SUBJECT?: The only previous quantitative study that examined nurses' use of assessment tools to identify antipsychotic medication side effects found that about 25% of mental health nurses were using assessment tools. No previous studies have examined factors that influence the manner in which mental health nurses assess antipsychotic medication side effects. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: One-third of the respondents were not aware of any antipsychotic medication side-effect assessment tool, and only one-quarter were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools, indicating that respondents with more positive attitudes to their service were more likely to continue using antipsychotic medication assessment tools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The low level of awareness and use of antipsychotic medication side-effect assessment tools indicates that nursing educational institutions should incorporate more detail about these tools in course content, and emphasize in particular the benefits that result from the use of these tools in clinical practice. Service processes contributed significantly to the use of antipsychotic medication assessment tools, which indicates that managers need to foster workplace cultures that promote routine use of these tools. ABSTRACT: Introduction Limited evidence suggests that only a minority of mental health nurses regularly use standardized assessment tools to assess antipsychotic medication side effects, but the factors that contribute to the non-routine use of these tools remain unknown. Aim To examine Australian mental health nurses' awareness of, and attitudes towards, side-effect assessment tools, and also identify factors the influence the use of these tools. Methods A cross-sectional survey was undertaken through distributing an online questionnaire via email to members of the Australian College of Mental Health Nurses. Completed questionnaires were received from 171 respondents. Linear regression was used to examine the relationship between the 'service responsibility' and 'personal confidence' scale scores, and awareness, previous use and ongoing use of antipsychotic medication assessment tools. Results Only one-quarter of the respondents (26.5%) were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools (Β = 3.26; 95% CI 0.83-5.69). 'Personal confidence' did not influence the ongoing use of assessment tools (Β = -0.05; 95% CI -1.06-1.50). Implications for clinical practice Stakeholders can incorporate 'service responsibility' processes to foster increased use of assessment tools, which may enhance the identification antipsychotic medication side effects and improve the quality of care for service users.

The experience of acupuncture care from the perspective of people with chronic low back pain: a grounded theory study.

OBJECTIVES: To explore the experience of acupuncture care from the perspective of people with chronic low back pain. METHODS: A grounded theory, qualitative study using indepth interviews was undertaken with 11 people who had received acupuncture care for chronic low back pain. Interviews were audio-recorded and transcribed verbatim. Initial, focused and theoretical coding were used to identify a core category and several other categories. RESULTS: The core category, Reclaiming Control, was related to the sense of well-being experienced by most of the participants as a result of undergoing acupuncture care. The other categories were Gaining Sanctuary, Gaining Trust and Working Together. These categories reflected the processes of participants entering an aesthetically appealing, calm and relaxing space; developing confidence in the acupuncturists' ability to care for them; and negotiating strategies and sharing decision-making with acupuncturists about their care. CONCLUSIONS: Clinicians using acupuncture as a management strategy for low back pain may elicit an immediate sense of calmness in patients with subsequent well-being benefits. A sense of calmness may also be enhanced through providing a relaxing physical environment. The transactional and interpersonal processes of establishing trust and rapport, and shared decision-making are important for clients. Shared decision-making can be improved by clinicians carefully considering the explanation of issues and plans to a particular patient, especially by developing an understanding of each patient's worldview and using language that the suits each individual's healthcare orientation. Our findings should be interpreted cautiously as the results may be generalisable only to private practice in affluent countries, and whether the findings are representative beyond this setting remains unclear.

Evidence-based practice in chiropractic practice: A survey of chiropractors' knowledge, skills, use of research literature and barriers to the use of research evidence.

BACKGROUND: Scant research has been undertaken regarding chiropractors' skills and knowledge associated with evidence-based practice (EBP), and their perceived barriers to EBP. These issues appear to have been examined in only one small qualitative study and one small study of chiropractors holding orthopaedic diplomas. The lack of research in this area suggests that additional studies are warranted to develop a better understanding of factors that affect chiropractors' use of research evidence in clinical practice. METHODS: We used a modified online questionnaire that captured information regarding EBP skills and knowledge, and barriers to EBP. Its adaption was informed by the use of a content validity panel. The questionnaire was disseminated through email by Australian chiropractic professional organisations and the Chiropractic Board of Australia. Logistic regression analyses were conducted to examine univariate associations between responses to items measuring knowledge and skills with items measuring: age; years since registration; reading research literature; and use of research literature in clinical decision-making. RESULTS: 584 respondents returned questionnaires. About half of the respondents stated they had learned the foundations of EBP (56.6%) during their undergraduate training. Slightly more than two thirds of the respondents were confident in their ability to critically review literature (69.5%) and find relevant research to answer clinical questions (72.6%). The most common factors involved with reading more research, and increased use of research literature in clinical decision-making, were confidence in critical appraisal skills and confidence in finding relevant research literature. Conclusion Educational interventions should be implemented to enhance Australian chiropractors' fundamental EBP skills.

Acupuncturists' perspectives on outcome measures to evaluate acupuncture care for chronic low back pain.

OBJECTIVES: To examine Australian acupuncturists' perspectives of: chronic low back pain outcome domains; their use of outcome measures to assess chronic low back pain; and their attitudes and perceptions of barriers to using the existing measures to evaluate acupuncture care for chronic low back pain. DESIGN: A postal questionnaire was used in a cross-sectional survey. PARTICIPANTS: 359 randomly selected Australian acupuncturists. RESULTS: 139 questionnaires were returned (response rate: 38.7%). The respondents' demographic characteristics were similar to Australian Bureau of Statistics acupuncturist demographic data. Overall, acupuncturists endorsed a broad approach to assessing acupuncture care for chronic low back pain. However, they had typically used pain severity measures but generally did not use other types of measures. Acupuncturists tended to hold positive attitudes towards using outcome measures. The principal barriers acupuncturists perceived to using outcome measures concerned doubts about whether the concepts which underpin acupuncture practice had been explicitly articulated and whether the available measures capture the specific context and particular outcomes of acupuncture care for chronic low back pain. IMPLICATIONS: The findings of this study suggest that a broad range of outcome measures are required to adequately assess chronic low back pain acupuncture care outcomes. While numerous outcome measures have been developed that are relevant to chronic low back pain care, whether these measures are appropriate for use by acupuncturists is unclear. Further studies are warranted to explore if established outcome measures are useful to evaluate chronic low back acupuncture care.

A survey of the uptake and implementation of research evidence by South Australian acupuncturists in clinical practice: attitudes and associated predictive factors.

OBJECTIVE: To examine South Australian acupuncturists' attitudes towards the use of research evidence and concurrently identify predicative factors associated with the uptake and implementation of research evidence. METHODS: Questionnaires were mailed out to the entire South Australian acupuncturist population (n=94). The population was divided into two groups, medical acupuncturists (general practitioners or other medical specialists) and non-medical acupuncturists, as previous studies have suggested that clinicians' attitudes to EBP are particular to the clinical setting. RESULTS: The total response rate to the survey was 76.6% (n=72). The difference in response rates between non-medical acupuncturists (90.9%, n=60) and medical acupuncturists (42%, n=12) was significant (p<0.0001). Over half of all respondents had both prior research training and previous research experience. Both groups held positive attitudes to research utilization, the use of research information was considered to be an important component of their professional practice, although they prioritized patient care over both reading research evidence and undertaking primary research. There was no significant difference in research interest between groups. The only predicative factor that influenced research utilization was related to the non-medical acupuncturists period of time in practice; non-medical acupuncturists interest in research (rho=-0.29, p=0.036) declined as they accrued clinical experience. No predictive factors were identified for the medical acupuncturist group. CONCLUSION: South Australian acupuncturists hold favorable views towards research utilization and consider the integration of research evidence into clinical practice as an important component of professional development. Professional associations should implement strategies which capitalize on the respondents' positive attitudes in order to ensure high quality evidence-based care for patients seeking acupuncture.