An exploration of the knowledge and experiences of  Mental Health Nurses in the screening for metabolic syndrome among people with Serious Mental Illness.

Michael Flanagan, RPN.

Historically people with serious mental illness(SMI) have suffered higher rates of physical illness and premature mortality compared to the general population leading to some authors describing it as a ‘life shortening disease’ (Allebeck, 1989). Metabolic Syndrome (MetS) comprises a cluster of metabolic abnormalities that increase the risk of cardiovascular disease and has been identified as a significant pathological threat to people with SMI with prevalence rates in these populations exceeding general population rates.

High rates of MetS in people with SMI have been identified with international consensus groups calling for comprehensive screening of these populations. Current practice does not reflect these recommendations and mental health nurses (MHN’s) have been identified as a group that are in an ideal position to help tackle this emerging pathological threat. Despite this assertion there is little known about MHN’s current practices in screening for MetS.

The purpose of this study is to explore the knowledge and experiences of MHN’s working in an acute unit in the screening for MetS among people with SMI. The method employed for this study will be a qualitative descriptive approach. Data collection will be through semi-structured interview with participant’s responses audio-taped, transcribed verbatim and analysed using Collaizzi’s (1978) framework.

It is envisaged that the findings of this study can provide insight into current practices of screening for MetS. This can lead to recommendations for the development of local policies and specific screening methods and the provision of further training if deemed necessary. Dissemination of findings will be aimed at local, national and international forums with eventual publication in peer reviewed nursing journals.

Mental Health Reform: The Amalgamation of Acute Psychiatric Services in the South-East of Ireland.

Claire Hayes (R.P.N, Waterford Institute of Technology).

The study aims to explore organisational issues, which are associated with the amalgamation of two acute psychiatric services in the South-East of Ireland. Following a thorough investigation of the literature surrounding service mergers, organisational issues emerge as a prominent concern. Services have engaged in domestic and international mergers over the last few years in order to match the macroeconomic trends operating worldwide and more recently to cope with the current global financial crisis. The national Government policy document A Vision for Change (2006) highlights the importance of closing all psychiatric institutions, in an effort to enhance a community-based model of care and modernisation of mental health infrastructure. Therefore, considering acute psychiatric services will continue to amalgamate in the near future, complying with the policy guidelines, organisational issues remain a priority in order to achieve successful and efficient service mergers.

A case study design will be applied to best meet the requirements of the research. The study will purposively target and recruit individuals, who have dealt with the Waterford and Wexford amalgamation process to date. Both cases being Waterford and Wexford will be interviewed using a semi-structured framework to gain an in-depth understanding of the organisational issues, which have affected the merger process. Collectively, the data gathered will address the research objectives of the study as well as contribute to the conclusions drawn from the study. Finally, the Miles and Huberman (1984) approach to data analysis will be employed, drawing conclusions on the organisational issues surrounding the merger process within the specified mental health setting.

Nurse-Patient Relationship

Ingrid Masterson

Concern is growing in Irish society around mental health and associated issues such as suicide and child welfare. Dissatisfaction and controversy around services offered by health care providers to engage with these problems is evident. Patient –practitioner interaction is an important aspect of this service. Nurses are a professional group who have intimate and ongoing front-line interaction with distressed patients; their experience has been an increasing focus of research in the English speaking world; articles review different aspects of the nurse-patient relationship in the light of a broader understanding of social and psychological contexts affecting mental health. In Ireland a number of studies have been undertaken on the stresses experienced by nurses, and students in training. This scoping project enquires into the experience of three nurses and the perceptions of three front-line managers in mental health care in different settings in the Leinster region from a qualitative perspective; it focuses on nurses’ emotional experience of nurse-patient interaction. Sociological theories underpinning the research draw on the social construction of mental illness; inter-disciplinary relationships; theories of subjectivity; emotional processes as described by Freund and Gendlin; symbolic/interpretive interactionism, (Goffman, Denzin); and draws on a Foucauldian perspective from a UCD thesis on mental illness (Smyth).  The psychosocial approaches current in the mid C20 to illuminate practitioner-patient experiences in psychiatry are reviewed, as well as developing shifts away from the prevalent bio-medical model in mental health nursing. 

Standards Based Audit Of The Centre for Living (Community Based Acute Day Hospital)

Timmy Frawley, Louise Battersby, Brian Maguire, Aiveen Kirley, Faiza Jabbar, Farhan Haque, Jill McHale, Aisling McClenaghan

This is an observational , retrospective  standards based  audit of an acute mental health day hospital, Centre  for Living (CFL). This audit primarily  aims to measure  CFL  activity  in year 2009  and compare   current CFL  performance against standards  set out by quality frame work Document by  Mental Health Commission (MHC ),as part of quality improvement process . Mental health commission recommends using  quality frame work standards  nationally across services as  a guide to transparent  service delivery  and an  indicator to measure  quality and performance. MHC  itself  will be using  same  Standards and associated criteria  annually for monitoring of mental health services nationally. The findings from this study will be used towards  continuous quality process  and  further  performance improvement and  better service delivery to patients.

Are psychiatric nurses supporting the needs of children whose parent has a mental health problem?

Derry Houlihan, MSc; BNS(hons); RPN; RGN. Community Mental Health Nurse, Health Service Executive, Dublin North Central. derry.houlihan@hse.ie

Prof. Agnes Higgins, Professor of Mental Health Nursing, School of Nursing & Midwifery, Trinity College Dublin. ahiggins@tcd.ie 

International research recognises that children are vulnerable to the potential negative impact of parental mental ill-health and possible parental separation through hospitalization. Within Ireland, the ‘Vision for Change’ document directs that adult mental health care providers to foster child centred practices that are supportive and protective of these children’s health and wellbeing. Presently no Irish nursing research exists regarding this aspect of mental health care. There is however, international research that recognises that children are vulnerable to the potential negative impact of parental mental ill-health and possible parental separation through hospitalization. This poster will present some of the findings from a study that sought to establish the current knowledge, attitudes and practice of Irish psychiatric nurses towards the support needs of children whose parent has a mental health problem. A questionnaire designed by the researchers was sent to a census sample of 180 RPNs (Registered Psychiatric Nurses) working in an integrated Mental Health Service in Ireland. The findings from this study suggest that although nurses are mindful of documenting if service users are parents, the children often do not form part of the ill parents nursing care plan and the respondents in this study indicated a lack of knowledge and confidence in this area of practice. The findings of the study highlight a need to increase knowledge among psychiatric nurses on the potential impact of a parental mental health problem on a child and provide for the children’s subsequent support needs.

‘Mental Health Nurses Experiences of Caring for Adolescents Who Engage in Deliberate Self Harm’

Margaret Bourke, (R.P.N.) (Student in Msc. Mental Health (Child, Adolescent & Family Strand) Trinity College, Dublin.

Pádraig Mc Bennett (R.P.N. R.G.N.)  B.Sc (hons). M.Sc. Lecturer, Trinity College, Dublin.

According to the literature, deliberate self harm (DSH) among young people is a major concern to health, social, educational and criminal justice services across Europe (Anderson et al 2007). The literature identifies that there are strong links between suicide and previous attempts of deliberate self harm. Hawton et al, (2003) report that between a quarter and a half of those committing suicide have previously carried out a non-fatal act. Mental Health Nurses working within adolescent Mental Health units experience constant interaction with young people who engage in deliberate self harm. Anderson (1999) identifies that they are at the forefront of contributing to future ways of intervening and working with this group of individuals.  How mental health nurses intervene at this point of contact may have a significant influence on how an adolescent responds to the support they are offered.  There is a paucity of research on this subject in an Irish context. Therefore, the aim of the research study is to investigate mental health nurses experiences of caring for young people who engage in deliberate self harm within an Irish mental health inpatient setting. The study was conducted using a qualitative descriptive approach. A purposeful sample of six Mental Health Nurses was used. Information was gathered using semi-structured interviews. It is hoped that that the findings of this study   will facilitate nurses to reflect on their care giving, and will provide knowledge to inform future practice development and evaluation of services. The poster presentation identifies the conceptual framework in tabular form which formed the basis of my research study.

DETECT

Authors: M. Sutton, Clinical Nurse Specialist; A. Fetherston, Database Manager; A. Kelly Research Manage; E O’Callaghan, Professor of Psychiatry;

This project illustrates how a mental health education campaign can effectively educate key influencers of young people about psychosis and how to seek help

 BACKGROUND

Public education is a crucial element of any strategy to reduce the duration of untreated psychosis. Those who work with young people have a key role to play in identifying early warning signs and encouraging young people to seek treatment.

 TARGET AUDIENCE

The target audience was staff and volunteers in organisations working with young people between the ages of 15 and 35. These include educational, sporting, health, social services and community organisations.  Priority was given to those organisations and groups working with young people already experiencing some difficulty in their lives e.g. social workers, probation officers, counsellors, home school liaison officers.

 METHODOLOGY

We designed an education campaign to educate the target groups about psychotic illnesses. The specific aim of this campaign was to improve the target audiences’ skills in identifying early symptoms of psychosis and to provide them with clear guidelines on pathways to care and treatment. Presentations were delivered through MS Powerpoint to groups ranging from 10 to 100 people. Questionnaires were circulated among attendees pre and post presentation. The pre-presentation questionnaires evaluated the level of knowledge of mental illness, awareness of services available and perceived stigma. The post-presentation questionnaires assessed the level of improvement of participants’ knowledge and understanding of psychosis and available services at the conclusion of the presentation.

 CONCLUSION

Analysis of the results of these questionnaires indicates that the education campaign has been effective. The findings have helped us  to refine and continually improve our educational campaign to ensure it achieves the objective of reducing the duration of untreated psychosis.

Developing a collaborative peer and clinician led education intervention for service users with experience of psychosis and their families: Challenges & opportunities

Fiona Boyd, MSocSc., Research Assistant, School of Nursing & Midwifery, Trinity College Dublin.

Dr. Marianne Breen, Research Fellow, School of Nursing & Midwifery, Trinity College Dublin.

Dr. David Hevey, Lecturer, School of Psychology, Trinity College Dublin.

Prof. Agnes Higgins, Professor of Mental Health Nursing, School of Nursing & Midwifery, Trinity College Dublin.

Enduring mental health problems such as Schizophrenia Spectrum Disorders and Bipolar Disorder have a significant impact on the quality of life and wellbeing of the individual, family and significant others. There is limited research into the impact of peer led, or peer and clinician led information and support interventions for service users who experience psychosis and their families. In an attempt to rectify this deficit, the EOLAS project group received funding to develop a peer and clinician led information and support programme for people with severe mental health difficulties, family members and significant others in the Kildare/West Wicklow Mental Health Services area. The content and delivery format of this programme was developed in collaboration with service users, their families and clinicians.

In order to determined the content a number of focus groups was held with service users, their families and clinicians.  The focus groups were conducted by two project workers with varying experience of working with people who experience mental distress. To track the development and decision making process in-depth interviews were conducted with the project workers at regular intervals during the development of the programme. Thematic analysis of the data collected during these interviews identified several challenges and opportunities when developing a collaborative educational programme.

In addition to difficulties in recruitment, a key challenge encountered was that the service user focus groups and family groups identified different and contrasting needs and varying attitudes towards the mental health services. Consequently, two versions of the educational programme was designed – one for service users and one for families. Furthermore, the need for clinical supervision for the project workers during the facilitation of the focus groups became apparent. Strong feelings of anger and grief were frequently expressed by those attending the focus groups.

One of the main opportunities that emerged is that involving service users in the design stage ensured that the content was relevant to the EOLAS participants. It also enabled an adult education philosophy to underpin the course. For example, the programme was designed around a workbook in which the participants could apply the topics to their individual circumstances.

Therefore, this poster describes the process used to develop a collaborative peer and clinician led education intervention It also highlights both the opportunities and challenges that can be encountered during the design and delivery of such initiatives, and makes some recommendations for future work of this nature.

 The EOLAS programme and the EOLAS evaluation project are funded by the GENIO Trust.

Quality of Life in First Episode Psychosis

Ms. Laoise Renwick, RPN BNS PhD Candidate^{1, 2} Dr. John Lyne, MRCPsych¹ Dr. Liz Owens, MRCPsych¹ Dr. Brian O’Donoghue, MRCPsych¹ Mr. Kevin Madigan, RPN, BNS¹ Dr. Ahmed Errasoul, MRCPsych¹ Dr. Jonathan Drennan, RNID RPN RGN BSc M.Ed Dip Stat PhD² Dr. Ann Sheridan, RPN RGN RNT BNS M.Ed PhD² Mr. Anthony Kinsella, FIS MSc¹ Mr. Niall Turner, BScOT¹

¹ DETECT Early Psychosis Service ² UCD School of Nursing, Midwifery & Health Systems ³ UCD School of Medicine & Medical Science

Aim: To evaluate client perspectives of QOL and the relationship with clinical factors at presentation with first-episode psychosis (FEP).

Methods: 152 individuals were assessed with FEP in a defined catchment area (pop. 390,000) between 2009 and 2011 using measures of diagnosis (SCID-DSM-IV), symptomotology (SAPS, SANS, CDSS), current functioning (GAF), premorbid functioning (PAS), insight (Birchwood Scale), duration of untreated psychosis (DUP, Beiser Scale) and QOL (WQLI-Client Version).

Results: There were complete data for 79 individuals (48M, 31F). Clinical symptoms, including positive and negative symptoms, were not correlated with any domain of QOL. However, those with poorer insight reported less distress from symptoms (r=-.300, P=.015). Several QOL domains scores were significantly lower in those who displayed clinically significant depressive symptoms including general satisfaction (t(71)=2.063, P=.043), psychological well-being (t(67)=2.596, P=.012), symptoms (t(68)=1.974, P=.052), social relations (t(68)=3.008, P=.004),  weighted overall QOL (t(66)=3.244, P=.002) and unweighted overall QOL (t(71)=3.153, P=.002) than those without. Premorbid functioning and current functioning were not associated with any domain of QOL although the length of untreated psychosis (DUP) was negatively correlated with activities of daily living (ADL) (r = -.292, P=.022).

Conclusion: Depressive symptoms are consistently associated with client evaluations of QOL rather than symptoms of psychosis. Although less distress is seen in those who show less awareness of having a mental illness, longer durations of untreated psychosis are associated with greater impairment in basic living skills and functioning (ADLs).

Registered Psychiatric Nurses’ practice with mentally ill parents and their children/families within adult mental health services in Ireland

Anne Grant, Lecturer, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland,

It is estimated that 25 – 50% of adults known to mental health services have children.

The demands of parenting while managing a mental illness can be challenging. Whilst a parent’s mental illness may jeopardise their capacity to parent effectively, stress from the parenting role may in turn jeopardise their mental health.  Difficulties in parenting tend to occur at times of relapse and during the acute phase of the parent’s mental illness and can adversely affect both the parent and their children/families’ well being on a temporary and on an ongoing basis.  

 In A Vision for Change the Department of Health and Children (2006) recommended that mental health services should address the needs of service user’s children and support service users to realise their full potential as parents.  

 The purpose of this study is to benchmark Registered Psychiatric Nurse’s (RPN) family sensitive practices with mentally ill parents and their children/families in Ireland.  A sequential mixed methods approach will be employed with data collected over two phases.  In the first phase RPNs practicing within acute admission units, community mental health nursing services and homecare services will be invited to complete a national survey.  In the second phase a subsample of RPNs from the quantitative sample will be invited to expand upon the findings from the first phase through participating in semi structured interviews.

 RPN’s practice will be examined within the context of national and international mental health policy and international literature and practice. Recommendations will be made as to how RPN’s practice with mentally ill parents and their children/families can be further developed. 

Expressing sexuality: Mental health service users views

Eddie McCann RPN, RMN, MSc, PhD, FHEA

Postdoctoral Research Fellow, Trinity College Dublin.

Background: In many areas of health care, the subject of human sexuality would appear to be a neglected topic. This study focused on people with a medical diagnosis of schizophrenia.

 Aim: The aim of the investigation was to identify sexual and relationship needs as perceived by users of mental health services who were living in the community. The objectives of this mixed methods study were to discover the client's sexual experiences in the past and present and to elicit hopes and aspirations for the future. The potential obstacles to sexual expression were highlighted through an exploration of the client's subjective experiences of the issues that were important to them.

 Method: A total of thirty people agreed to be interviewed at a clinic in North London where they regularly attended to receive depot medication. Data were collected through: a questionnaire relating to demographic characteristics; an interview schedule incorporating the determinant factors of sexual behaviour through life; relevant sections of the Camberwell Assessment of Need; and a semi-structured interview designed specifically for the study.

 Findings: The findings reveal that people had clear ideas about what constituted a fulfilling intimate relationship. A majority of participants identified sex and relationship needs and aspired to having relationships in the future.

 Conclusions: Obstacles were highlighted and included: medication issues; body image; stigma and discrimination; safe sex issues; support and the opportunity to discuss concerns; and access to family planning services or sexual and relationship therapy. A model of psychosexual care is proposed that includes rigorous methods of engagement, assessment, intervention and evaluation strategies. Further recommendations are made in terms of practice, research, policy and education.  

Exam Students In the Mental Health Services

Michelle Creaven, RPN, Bernadette McCormack, RPN, Margaret Creaven, RPN, Marie Codyre, RPN,       Elsie Donohoe Curley, RPN, Gerard Grehan, RPN.

In the past number of years there has been an increase in the number of referrals to the Ballinasloe/Mountbellew adult mental health services of young people who are currently engaged in the examination process. In some instances they may have a pre existing mental health problem or this may have become apparent during the examination year. It was a challenge to the team to facilitate this group in achieving their goals, maintaining optimum mental health, while taking into account life stage challenges. Exam years are a very significant time in a young person’s life, influencing life choices and determining skills for dealing with future stress (McNichols, 2010). It is generally a time of great change physically and also a vulnerable time for the development or manifestation of a major mental illness (Mulfson 2006). Young adults in particular are developing the skills of impulse control and emerging into the adult world, negotiating their independence with their guardians Cartwright-Hatton, 2007). They are also dealing with the challenges of exposure to mind altering substances, peer pressure, societal pressure, media pressure and living independently, accepting a diagnosis that may be perceived as limiting and stigmatising to their peer group and family. They are acquiring new life skills that will provide them with the opportunity to achieve their goals, while accommodating health issues that may re occur through out their life (Office of Health and Children, 2009). Members of the team have developed skills in negotiating with outside agencies such as the Department of Education, secondary schools and third level colleges to arrange special accommodation for exams and exceptions for students. Providing service users with reassurance and empowering them to take on some of these roles themselves helps facilitate them in achieving their ultimate goals in life (Bates, 2001).

Drinking patterns and preferences among Irish substance abusing teens

Mr. Philip James, Ms. Caitríona Kearns, Dr. Bobby Smyth

Youth Drug & Alcohol (YoDA) Service, Health Service Executive

Staff at an Irish adolescent drug and alcohol service set out to determine the drinking patterns of clients accessing treatment. Client’s aged fourteen to eighteen (n=34) were invited to complete a brief questionnaire pertaining to their drinking habits. There were definite trends in the types of alcohol used by clients of the service, with beer and vodka being the preferred alcoholic beverages consumed. As evidence points to the idea that beer drinking in teenage years appears to be correlated to higher rates of alcohol dependence in early adulthood, it is perhaps not surprising that the drink of preference for our client group was lager. Brand Loyalty was also evident.  Budweiser lager and Smirnoff Vodka were the most commonly used alcoholic drinks of our client group. Fifty percent of adolescents accessing treatment reported that they usually drink Budweiser, with 26.5% citing Smirnoff. These are interesting findings in the light of the fact that there are cheaper alternatives on offer. Typical units consumed were 18.5 units by male clients and 17.5 by females.  Most of the client’s reported obtaining their alcohol in off licences, and frighteningly, despite that fact that respondents are currently attending treatment, 11% of clients informed us that it is their parents who buy the alcohol for them. Findings and future implications for research are discussed.