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Brunero S, Everett B, Ramjan LM, Salamonson Y, Steel K, Johnson AM, Stokes M, Langdon R, Dickens GL. Clarity, confidence and complexity: Learning from mental health nurses' experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings. J Clin Nurs 2020; 29:1102-1114. [PMID: 31793106 DOI: 10.1111/jocn.15126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/13/2019] [Accepted: 11/10/2019] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVE To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. BACKGROUND Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. METHOD An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. RESULTS Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability); (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes); and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). CONCLUSION The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. RELEVANCE TO CLINICAL PRACTICE Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance.
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Affiliation(s)
- Scott Brunero
- Prince of Wales Hospital, Randwick, NSW, Australia.,Centre for Applied Nursing Research (CANR), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Bronwyn Everett
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Lucie M Ramjan
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Yenna Salamonson
- Centre for Oral Health Outcomes and Research Translation (COHORT), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Kelly Steel
- Bankstown Mental Health, Banks House, Bankstown Hospital, Sydney, NSW, Australia
| | | | - Malcolm Stokes
- South Western Sydney Mental Health, Mental Health Centre, Liverpool Hospital, Liverpool, NSW, Australia
| | - Rachel Langdon
- Centre for Applied Nursing Research, Western Sydney University/South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Geoffrey L Dickens
- Centre for Applied Nursing Research (CANR), School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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Dickens GL, Ramjan L, Endrawes G, Barlow EM, Everett B. Effectiveness and experiences of mental health nurses in cases of medical emergency and severe physiological deterioration: A systematic review. Int J Nurs Stud 2019; 95:73-86. [PMID: 31121386 DOI: 10.1016/j.ijnurstu.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/21/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND From a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses' delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated. OBJECTIVES To systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient. DESIGN A systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Multiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms. REVIEW METHODS Inclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses' emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted. RESULTS A total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice. CONCLUSIONS There are currently no validated instruments to investigate mental health nurses' emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups' emergency care-related practice.
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Affiliation(s)
- Geoffrey L Dickens
- Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Western Sydney University and South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
| | - Lucie Ramjan
- Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Western Sydney University and South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia; School of Nursing and Midwifery, Western Sydney University, Building EB/LG Room 35, Parramatta South Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Gihane Endrawes
- School of Nursing and Midwifery, Western Sydney University, Building EB/LG Room 35, Parramatta South Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Emily May Barlow
- Division of Mental Health Nursing and Counselling, School of Social and Health Sciences, Abertay University, Bell Street, Dundee, DD1 1HG, United Kingdom.
| | - Bronwyn Everett
- Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Western Sydney University and South Western Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia; School of Nursing and Midwifery, Western Sydney University, Building EB/LG Room 35, Parramatta South Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Porter JE, Cant R, Missen K, Raymond A, Churchill A. Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies. Int J Ment Health Nurs 2018; 27:1364-1370. [PMID: 29701885 DOI: 10.1111/inm.12467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 12/21/2022]
Abstract
Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011-2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals' quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the 'Worried' category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the 'Worried' category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am-12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.
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Affiliation(s)
- Joanne E Porter
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia
| | - Robyn Cant
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia
| | - Karen Missen
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia
| | - Anita Raymond
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia
| | - Anne Churchill
- School of Nursing, Midwifery and Healthcare, Federation University Australia, Churchill, Victoria, Australia
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Pfeiffer Y, Schwappach D. Taking up national safety alerts to improve patient safety in hospitals: The perspective of healthcare quality and risk managers. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 110-111:26-35. [PMID: 26875033 DOI: 10.1016/j.zefq.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts? METHODS A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented. RESULTS The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals. CONCLUSIONS To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts.
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Affiliation(s)
- Yvonne Pfeiffer
- ETH Zurich, Department of Management, Economics, and Technology, Zurich, Switzerland
| | - David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
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Flood C, Matthew L, Marsh R, Patel B, Mansaray M, Lamont T. Reducing risk of overdose with midazolam injection in adults: an evaluation of change in clinical practice to improve patient safety in England. J Eval Clin Pract 2015; 21:57-66. [PMID: 25109525 DOI: 10.1111/jep.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 01/14/2023]
Abstract
RATIONALE AIMS AND OBJECTIVES This study sought to evaluate potential reductions in risk associated with midazolam injection, a sedating medication, following a UK National Patient Safety Alert. This alert, 'Reducing risk of overdose with midazolam injection in adults', was sent to all National Health Service organizations as a Rapid Response Report detailing actions services should take to minimize risks. METHOD To evaluate any potential changes arising from this alert, a number of data sources were explored including reported incidents to a national reporting system for health care error, clinician survey and audit data, pharmaceutical purchasing patterns and feedback from National Health Service managers. RESULTS Prior to the Rapid Response Report, 498 incidents were received by the National Patient Safety Agency including three deaths. Post-implementation of the Rapid Response Report (June 2009), no incidents resulting in death or severe harm had been received. All organizations reported having completed the Rapid Response Report actions. Purchase and use of risk-prone, high-strength sedating midazolam by health care organizations decreased significantly as did the increased use of safer, lower strength doses (as recommended in the Rapid Response Report). CONCLUSIONS Organizations can achieve safer medication practices, better knowledge, awareness and implementation of national safer practice recommendations. Risks from inadvertent overdose of midazolam injection were reduced post-implementation of national recommendations. Ongoing monitoring of this particular adverse event will be required with a sustained patient safety message to health services to maintain awareness of the issue and reduction in the number of midazolam-related errors.
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Affiliation(s)
- Chris Flood
- NIHR Health Service & Delivery Research Programme, National Patient Safety Agency, London, UK
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