'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.

Management of work stress and burnout among community nurses arising from the COVID-19 pandemic.

The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

Falls and older people: preventative interventions.

Falls among older people are a major public health challenge, because the sequelae of falls can be severe, both in terms of mental and physical health repercussions. Building on an earlier article that discussed the reasons why older people fall, this article describes the interventions that may help reduce falls among older people. Four interventions which could be applied within UK community settings, namely, the Otago programme, the falls management exercise programme, tai chi and home assessment and modification are outlined here. District nurses are well placed to contribute to a reduction in falls among older people by identifying those susceptible to fall risks among their clients and putting in place the necessary interventions to minimise them.

Falls and older people: understanding why people fall.

Falls are common among older people and a major public health challenge. This article describes why falls are more common among older people, the potential causes of falls and what assessments should be undertaken to inform preventive interventions. District nurses are well placed to contribute to the understanding of why an older person has had a fall as part of a falls risk assessment.

Life is for living: the contribution of the arts and gardens.

Quality of life and life enrichment are important throughout the lifespan and no less during ill-health or later life. The role of the arts and gardens and their potential benefits are not prominent within healthcare practice. This paper outlines the evidence reported in two literature reviews, one addressing the arts and the other focusing on gardens and gardening so that district nurses can understand what art-based and gardening opportunities they may offer their clients and their carers.

Healthcare transition for adolescents and young adults with long-term conditions: Qualitative study of patients, parents and healthcare professionals' experiences.

AIM AND OBJECTIVES: To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND: Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN: Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS: Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS: Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS: The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE: Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.

Older people living alone in Shanghai: A questionnaire survey of their life experience.

Globally the number of older people living alone is increasing. Little is known about the life experience of older people living alone in Mainland China. This study aimed to explore older people's experience regarding different components of their lives. A cross-sectional survey of 387 older people aged 60 years and above and living alone in two communities in Shanghai was conducted from April to July 2015. A structured questionnaire including 15-item Geriatric Depression Scale, Activity of Daily Living Scale, UCLA Loneliness Scale version 3, Social Support Rate Scale and Older People's Quality of Life Questionnaire was used to assess the health status, loneliness, social support, quality of life and demographic information. A total of 15.7% of the participants rated their health as poor with 56.8% reporting chronic diseases and 26.9% reporting being depressed. A total of 71.1% of the participants reported a high level of functional ability. However, 54.3% and 21.7% of the participants reported a moderately and moderately high level of loneliness respectively. The median of SSRS was 30 and the mean of Older People's Quality of Life Questionnaire was 120.2, indicating a lower level of social support and quality of life. There were statistically significant differences in health, loneliness, social support and quality of life across the participants with different characteristics. Interventions to improve the health status, reduce loneliness, increase social support and maintain or improve quality of life of older people living alone in Shanghai could be developed and implemented. Potential interventions include providing frequent home care services, early detection of depression, encouraging more contacts from children and other family members, and providing support from other sources.

Transition from paediatric to adult healthcare for young people with cystic fibrosis: Parents' information needs.

Parents of young people with cystic fibrosis (YPWCF) play an important role during the transition from paediatric to adult health services. There is limited evidence on parental information needs and the extent to which they are met. An online survey was conducted targeting a finite population of 190 parents of YPWCF in Ireland. Fifty-nine parents responded (31% response rate). Parents reported the need for more general preparation and timing of the transfer, more information regarding the differences between adult and child health services and how their child will self-manage his/her illness in the future. Most parents received information on the timing of transfer and new healthcare providers but reported being insufficiently informed about their legal status relating to medical confidentiality for their adult child and community resources available for their child after transition to adult health services. The findings highlight the importance of information and preparation for caregivers as well as young people to promote successful transition to adult healthcare. Providing parents with clear information and anticipatory guidance are simple changes in practice that may lead to improvements in transition experiences.

Improving transition to adult healthcare for young people with cystic fibrosis: A systematic review.

As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.

General practice nursing: who is cherishing this workforce?

The remodelling of the NHS requires a strong general practice nurse (GPN) workforce within general practice. The challenges facing general practice nursing are set within the current policy context and recent available evidence and illustrated by drawing upon the experience of a current GPN working in London. It is argued that there is a need to support the professional development of GPNs and nurture the next generation of potential GPNs if the current shortage of GPNs is to be addressed.

Nurses' smoking habits and their professional smoking cessation practices. A systematic review and meta-analysis.

BACKGROUND: A better understanding of whether nurses' own smoking behaviours influence their engagement with smoking cessation interventions is needed. AIM: To establish whether the smoking status of nurses is associated with their professional smoking cessation practices. METHODS: Twelve electronic databases covering English and Spanish language publications from 01 Jan, 1996 to 25 Mar, 2015 were systematically searched. Studies were included if they reported nurses' smoking cessation practices in relation to their personal smoking habits. Proportions of nurses' smoking status and smoking cessation practices were pooled across studies using random effects meta-analysis. RESULTS: Fifteen studies were included in this systematic review. Levels of reportedsmoking cessation interventions were generally low across the studies. The meta-analyses suggested that nurses' personal smoking status was not associated significantly with nurses always asking patients about their smoking, but nurses who smoked were 13% less likely to advise their patients to quit and 25% less likely to arrange smoking cessation follow-up. More intense interventions (assessing motivation and assisting) were not significantly associated with the smoking status of the nurse. CONCLUSIONS: The smoking status of nurses appears to have a negative impact in the delivery of smoking cessation practices. The overall level of nurses' engagement with the delivery of smoking cessation interventions requires attention if nurses are to be effective agents of smoking cessation.

An innovative strategy to increase a professional workforce: the fast track initiative for health visitors in England.

OBJECTIVES: Fast tracking is one strategy that organizations use to ameliorate workforce shortfalls by attracting new recruits, and accelerating their skills development and experience. In response to the Government's target of rapidly expanding the number of health visitors in England's National Health Service, the fast track initiative was launched to recruit newly qualified (fast track) as well as experienced (standard entry) nurses and midwives onto health visiting programmes. This paper evaluates the fast track initiative, from the perspective of fast track and standard entry students, practice teachers and health visitor managers. METHODS: A mixed methods design was used comprising a questionnaire survey (n = 71 students), semi-structured interviews (n = 37 students), telephone interviews (n = 13 managers) and six focus groups (n = 24 practice teachers). Data were collected between April 2012 and July 2013. Descriptive statistics, t-tests and the Pearson Chi-square test were used to analyse the quantitative data. The qualitative data were analysed thematically. RESULTS: Motivations for health visiting as a career choice were similar for fast track and standard entry students, with career progression and interest in health promotion being key motivators. There was consensus that personal qualities and characteristics were more important than experience or qualifications. However, fast track students were significantly less confident about their public health competencies in leadership and management (p < 0.05) and communication (p < 0.02). Practice teachers and managers also reported that fast track students required more intensive supervision particularly at the beginning of the programme. Programme completion including pass rates and academic achievement showed no significant difference by route of entry (p > 0.5). CONCLUSION: Fast tracking offers a useful recruitment strategy in order to expand the health visitor workforce, but longitudinal research is needed to confirm benefits such as retention and career trajectories.

The impact PICU nursing expertise has on a child's unplanned extubation.

BACKGROUND: Unplanned extubations in PICU are used as a measure of quality in clinical governance strategies. While many factors, such as sedation or unit activity, impact negatively on unplanned extubations, high nurse-patient ratios reduce adverse patient events and improve patient safety. However, optimal nurse-patient ratios and the impact of the level of nursing expertise on the quality of care are unknown. AIM: The study aimed to examine the impact of PICU nursing expertise on the unplanned extubations of children. DESIGN: Audit and analysis of existing adverse event patient and nurse workforce data. METHOD: This single-centre study examined unplanned extubations at a mixed general and cardiac tertiary PICU in the UK. Routinely collected data from nursing and adverse incident databases were examined. The dataset included over 74,477 nurse allocations between August 2006 and April 2011. Unplanned extubations were the adverse event of interest. RESULTS: A total of 78 unplanned extubations occurred between April 2006 and April 2011. The majority of unplanned extubations occurred when patients were looked after by junior nurses. The seniority of the nurse in-charge and the qualifications of the patient's nurse were not related to unplanned extubations. However, more unplanned extubations occurred at times of higher patient occupancy. CONCLUSIONS: Nursing expertise and nurse-patient ratios were not related to unplanned extubations in this study. Further research is needed to explore the non-workforce factors such as the securing of endotracheal tubes, sedation levels and unit activity and their relationship with adverse events. RELEVANCE TO CLINICAL PRACTICE: In paediatric intensive care units where nurse-patient ratios are high, further investigation is needed to establish what impact non-workforce factors have on unplanned extubations.

Experiences and Outcomes of Transition from Pediatric to Adult Health Care Services for Young People with Congenital Heart Disease: A Systematic Review.

This review synthesizes the empirical literature on outcomes and experiences of transfer and transition from pediatric to adult care for young people with congenital heart disease. A systematic review of papers published between January 2001 and May 2013 that examined outcomes or experiences of transfer and transition among young people with congenital heart disease was conducted. Data were extracted by two independent reviewers with the outcomes data combined using narrative synthesis and the experiences data integrated using thematic synthesis. Thirteen papers were included in the review: six reported outcomes following transfer, six reported experiences of transfer and transition, and one reported both outcomes and experiences. The review data indicate that high proportions of young people were lost to follow-up or experienced long gaps in care after leaving pediatric cardiology. Factors that protected against loss to follow-up or lapse in care included: beliefs that specialized adult care was necessary; poorer health status; attendance at pediatric appointments without parents; and pediatric referral to an adult congenital heart disease center. Data on experiences highlighted that many young people were unconcerned about transition, but lacked knowledge about their condition and were insufficiently prepared for transfer. In terms of adult services, many young people desired continuity in the quality of care, youth-oriented facilities, a personalized approach, and for their parents to remain involved in their care, but in a secondary, supportive capacity. In conclusion, the high proportions of young people lost to follow-up highlight the need for formal transition programs, which ensure a planned and coordinated transfer. Patients with congenital heart disease need education throughout adolescence about the implications of their condition, the differences between pediatric and adult services, and self-care management.

Promoting healthy behaviours - do we need to practice what we preach?

The UK faces a public health challenge arising from unhealthy behaviours. Some health care workers engage in the same unhealthy behaviours as the general population. This paper explores the issues arising from some primary care staff adopting unhealthy behaviours upon healthcare organisations, professional practice and patient perceptions in terms of the promotion of health in the primary care setting.

Factors contributing to registered nurse medication administration error: a narrative review.

OBJECTIVE: To explore the factors contributing to Registered Nurse medication administration error behaviour. DESIGN: A narrative review. DATA SOURCES: Electronic databases (Cochrane, CINAHL, MEDLINE, BNI, EmBase, and PsycINFO) were searched from 1 January 1999 to 31 December 2012 in the English language. 1127 papers were identified and 26 papers were included in the review. Data were extracted by one reviewer and checked by a second reviewer. REVIEW METHODS: A thematic analysis and narrative synthesis of the factors contributing to Registered Nurses' medication administration behaviour. Bandura's (1986) theory of reciprocal determinism was used as an organising framework. This theory proposes that there is a reciprocal interplay between the environment, the person and their behaviour. Medication administration error is an outcome of RN behaviour. RESULTS: The 26 papers reported studies conducted in 4 continents across 11 countries predominantly in North America and Europe, with one multi-national study incorporating 27 countries. Within both the environment and person domain of the reciprocal determinism framework, a number of factors emerged as influencing Registered Nurse medication administration error behaviour. Within the environment domain, two key themes of clinical workload and work setting emerged, and within the person domain the Registered Nurses' characteristics and their lived experience of work emerged as themes. Overall, greater attention has been given to the contribution of the environment domain rather than the person domain as contributing to error, with the literature viewing an error as an event rather than the outcome of behaviour. CONCLUSION: The interplay between factors that influence behaviour were poorly accounted for within the selected studies. It is proposed that a shift away from error as an event to a focus on the relationships between the person, the environment and Registered Nurse medication administration behaviour is needed to better understand medication administration error.

Self-rated health and associated factors among older people living alone in Shanghai.

AIM: Self-rated health is a reliable and important health measure related to older people's mortality and quality of life. Few studies regarding the self-rated health of older people living alone have been carried out in Mainland China. The present study aimed to investigate the self-rated health of older people living alone in Shanghai and its associated factors. METHODS: A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed structured questionnaires through face-to-face interviews. The data collected included self-rated health, physical health, depression, functional ability, physical activity, health services satisfaction, loneliness, social support and sociodemographic variables. RESULTS: More than two-fifths of the participants (43.2%) reported good self-rated health. Multinomial logistic regression analyses found that chronic disease, acute disease, functional ability, satisfaction with health services, depression and age were predictors of self-rated health. CONCLUSIONS: Identifying factors associated with the self-rated health of older people living alone could inform the delivery of appropriate health and social care interventions to promote older people's health.

Post-traumatic growth in mothers of children with autism: a phenomenological study.

While the adverse effects of raising a child with autism are well demonstrated, there have been few reports of the post-traumatic growth of mothers of children with autism. The purpose of this research was to explore dimensions of post-traumatic growth in this population in Mainland China and identify the factors facilitating post-traumatic growth. A total of 11 mothers of pre-school children were recruited from five rehabilitation centres of children with disabilities in Shanghai. The semi-structured interviews were conducted between August 2012 and October 2012 and analysed using thematic analysis. The data partially confirmed Tedeschi and Calhoun's model of post-traumatic growth. A new philosophy of life, appreciation of life, relating to others, personal strength and spiritual change were five domains of post-traumatic growth in mothers of children with autism. Perceived social support, peer example, effective coping style and self-efficacy enhancement were facilitating factors of post-traumatic growth. Further studies are needed to understand how to promote the post-traumatic growth of mothers of children with autism.

Nurses' attitudes towards older people and working with older patients: an explanatory model.

AIM: To establish an explanatory model of registered nurses' attitudes towards older people and working with older patients. BACKGROUND: Increasing demands for health-care from an ageing population will require a higher proportion of nurses who have positive attitudes towards older people and like working with older patients. METHOD: A convenience sample of registered nurses (n = 579; 79.3% response rate) attending continuing professional education courses within a large university in London was surveyed from October to December 2011. RESULTS: Registered nurses expressed positive attitudes towards older people and 89.7% reported positive attitudes towards working with older patients. The variables of self-ageing anxiety, attitudes towards health-care resource allocation, knowledge of ageing, ethnic group, job title, attitudes towards older patients and interaction between ethnic group and attitudes towards working with older patients explained 42.6% of the variance in attitudes towards older people. Factors, including attitudes towards older people, self-ageing anxiety, commitment to nursing, attitudes towards health-care resources allocation among older people and clinical specialty explained 16.7-34.3% of the variance in attitudes towards older patients. CONCLUSION: The models identified several related factors that may help in the selection and management of nurses for caring older people. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings highlight the importance of investing in continuing education related to gerontological nursing and the ageing process so that there is a growing pool of registered nurses who wish to care for older patients.

Maximising influenza vaccination uptake among older people.

Older adults aged 65 years and over are particularly vulnerable to seasonal influenza as their immune system is weaker than that of younger adults. The influenza vaccination helps to reduce influenza severity and the incidence of complications, but a range of factors can affect uptake among older people. These factors can be categorised as follows: the system of vaccination; influenza vaccination mistrust and fear of side-effects; health beliefs and behaviours; and other factors. Various interventions to maximise influenza vaccination uptake among older people in the community have been identified, including: interventions to increase community demand, enhance access and improve influenza vaccination among community nurses, as well as provider or system-based interventions and societal interventions. Community nurses have been found to have a positive influence on influenza vaccination uptake and should continue to promote the benefits of influenza vaccination to their patients who are 'persistent decliners'.