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Nursing interventions for older person’s with depression and chronic physical illness in the in residential care setting

Patricia Collins (Acting Ward Manager, St. Ita’s Community Hospital. Newcastle West, Co Limerick)

Abstract

Background and context: Being in a residential setting and having a chronic physical illness/ illnesses contributes and exacerbates depression. This implies a growing need for nurses in general residential care settings to become more knowledgeable with regard to mental health issues of the clients they care for and to develop the skills of therapeutic relationship building to provide person centred assessments and interventions.

Aims and Objectives: The aim of this poster is to guide nurses caring for older residents with depression and chronic physical illness using person centred assessments, planning, intervention and evaluation skills. The objectives are to identify the skills required for nurses to complete comprehensive assessments, planning and evaluation of care, and to empower nurses to collaborate with the resident and multi disciplinary team in formulating a plan of care whilst ensuring the resident is central to the plan of care and exercises their choice at all stages.

Outline main content and processes used: Registered general nurses can provide therapeutic and person centred care to assist residents in their journey with depression. Within the context of exploring practice at a CNS level as part requirement of the graduate diploma in rehabilitation of the older person (nursing) the issue of caring for a resident with depression was explored.  This resulted in the development of a guide for registered general nurses to assess, plan, implement and evaluate interventions for residents suffering from depression.

Evaluation and outcomes: Evaluation should be carried out by observation, ongoing screening, collaboration and monitoring of quality outcomes for the resident.

Conclusions and Outcomes: Nurses working in residential care settings need to be knowledgeable and develop themselves professionally in mental health issues.

An evaluation of the Liaison Psychiatry Service provided in University Hospital Galway

Dr Shane McInerney, Alison Van Laar, Dr Emma Bainbridge, Prof Colm McDonald
(Department of Psychiatry, University Hospital Galway, Ireland)

Abstract

Aims:
(1) To document the details of the service provided by the Liaison Psychiatry service of University Hospital Galway (UHG) in a six month period from January to July 2009
(2). To provide information on the demographic details and the diagnosis of those presenting patients.

Method: An assessment form was designed to gather demographic and clinical information. The authors collected information from this logbook and from patient case notes.

Results: A total of 2638 patients were assessed by the Liaison Service in 2009. During January to July 2009, a total of 867 patients were seen. 49% were male, & mean age of patients was 34 (range 8 - 88). 3% were under 18. 32% of patients referred had not attended previously. 49% (429) were assessed after 5pm. The most common diagnoses was affective disorder at 26%, substance abuse accounted for 14%. 83% of patients that presented lived within the catchment area. 23% of patients were admitted to the Acute Psychiatric Unit. 43% were referred by A&E, 24% were self-referrals and 11% of patients were referred by their GP.

Conclusion: This service evaluation shows the broad spectrum of cases seen by the Liaison Psychiatry service in UHG. The introduction of a liaison psychiatric nurse and liaison registrar to the service has been a significant assistance to the provision of the liaison psychiatry service. The absence of a Consultant in liaison psychiatry means that the service is still suboptimal.

Managing stress during the recession

Niamh Gallagher (Nursing student, NUI Galway)

Abstract

We all experience some type of stress each day whether it’s the stress of work or the stress of traffic jams, at times its what keeps us most alert and focused on achieving our goals. In today’s time of economic recession the stress factors have increased which may often affect ones health both mentally and physically. Studies have shown that the recession has affected everyone of us in some way and has brought extra financial stresses to many households across Ireland (The Irish Times, 09).This poster presentation will demonstrate the added stress people are under during this economic recession. In recent times there have been media reports of at least ten suicides associated directly with the current downturn. The impact of stress will also be demonstrated, how it effects the body and the mind. Coping mechanisms to overcome stress during this recession even simple everyday exercises will be illustrated.

Physical activity (PA) for patients with enduring mental illness

Claire Hayes. (Nursing student, Waterford Institute of Technology)

Abstract

The mental and physical health benefits of physical activity (PA) are internationally recognized (Wilmore et al. 2008; Jones and O’Beney 2004). However, PA as a nursing intervention does not appear to be adequately understood or appreciated by patients and mental health professionals alike (Callaghan 2004). Boredom is a significant issue among many psychiatric settings with patients wanting to leave wards as a result of the few therapeutic activities available (Langan and McDonald 2008). In addition, given Ireland’s current economic crisis, professionals need to find ways to deliver nursing care with limited resources. PA is an intervention, which is cost-effective and can be adopted by those with various mental illnesses, regardless of their skills and abilities. In addition, the issue of weight gain associated with neuroleptic medication highlights the significance and necessity of PA as an intervention. PA can include other forms of sustained movement such as gardening, yoga, house- cleaning and walking (Page 2008). Finally, PA interventions are a critical component of a biopsychosocial approach in recovery-oriented mental health settings. Whether it is an acute inpatient setting or community hostels, the psychological and physical benefits of PA remain convincing to the professional eye. Therefore, this poster aims to emphasize the benefits of PA and encourage professionals to consider PA as an essential intervention within clinical practice.

Follow the Leader? Using Experiential Drama in undergraduate Psychiatric Nurse Education

Margaret Prendergast, Ken Hogan, Rosaleen Murray, Mark Garavan, Siobhan Lynch.
(Dept of Nursing and Health Sciences, GMIT, Castlebar, Co Mayo)

Abstract

Psychiatric care in Ireland has undergone a recent and rapid development in treatment and care of people living with a medical diagnosis of mental illness. This move has been from a traditional institutionally based treatment towards a more community based, social model of care for service users and their families. This shift has refocused the need for a biological, psychological, social and spiritual approach in supporting service users, their families. In our attempts to meet these contemporary societal needs we recreated a learning environment whereby students could explore some of the experiences related to mental illness. Our aim, through the use of drama was to enhance learning and foster further student growth. Thus, the emphasis was on a developmental process, only one part of which was the external or public form that the drama experience took. It was anticipated that the student would explore their own creativity through drama and apply this personal learning to their area of work and life interactions. Symbolically, we saw a power shift in learning where students became initiators and the teacher played a supportive role. We suggest that drama provides a very useful medium which emancipates students in their learning and empowers them to visualise some of the challenges we all experience in our lives.

The Experience and Impact of Patient Suicide on In-Patient Practitioners.A questionnaire study of an in-patient multidisciplinary team

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Kevin McLaughlin (Mental Health Services for Older People, HSE West)

Abstract

Introduction: There is a recognized understanding of the impact of patient suicide on the family and survivors of suicide. Increasingly there is a growing awareness of the impact of patient suicide on the professional carers.

Aims & objectives: To investigate the personal and professional impact of patient suicide on the clinicians working within an in-patient multidisciplinary team. To identify current levels of support, and other supports that may be required, to minimize the impact of patient suicide.
Methodology: An intensive six-page questionnaire, containing qualitative and quantitative sections, was sent to ninety multidisciplinary team members of St. Columbus acute admissions unit, Sligo. A reminder letter was sent six weeks later.

Results: Thirty-nine questionnaires were returned (43%). 85% of respondents had been involved in the care of a patient who had died by suicide. 97% of clinicians reported some degree of impact on their professional life. Subsequent changes to professional practice included taking less therapeutic risks with patients (33%) and avoiding involvement with high-risk patients (21%). 97% reported an increased focus on suicide risk. 70% of clinicians reported some degree of impact on their personal lives. Emotional reactions such as shock, sadness, grief and fear (of blame by family and/or colleagues) were identified. Talking to colleagues, clinical supervision, speaking with friends and family and the acceptance of suicide as part of clinical practice all helped clinicians cope better with patient suicide.

Conclusion: Patient suicide has a significant effect (professionally and personally) on professional carers1-4, 6.. 70% believed that more could be done to support clinicians following a patient suicide. 58% believed they had not received adequate training in how to cope with patient suicide. Considering the suggested inevitably of patient suicide1,3. it would be beneficial to look at the current training programmes of each discipline to address this apparent deficit, and to further develop and promote postvention supports that are easily identifiable and accessible.

Improving Client Adherence with Treatment Regimes: Concordance Skills as a psychosocial intervention for Health Care Professionals

Fionnuala Jordan, Siobhan Smyth
(School of Nursing and Midwifery, National University of Ireland, Galway)

Abstract

Systematic reviews indicate that the prevalence of non-adherence with treatment regimes in the area of chronic disease is approximately 50%. Such poor adherence rates compromises the effective clinical management and treatment outcomes for the client. The purpose of this poster is to highlight the development of a blended learning module for health care professionals (HCP’s) titled ‘Empowering Clients to Self-Manage their own Chronic Disease’. The module aims to provide HCP’s with the knowledge, skills and key interventions that will facilitate them to engage in a collaborative, structured and practical way with clients, thus enabling them to self-manage their chronic diseases more effectively. The focus is on improving clients’ adherence to treatment regimes by using evidence based approaches underpinned by theoretical concepts. These will include motivational interviewing, cognitive behavioural therapy and concordance skills approaches that are an integral part of the empowerment process. The philosophy of empowerment, principles of adult learning and effective client-centred interventions to facilitate informed choice and optimal adherence are key themes in the module. The poster will illustrate through a clinical case study the key elements of the concordance approach that will include foundation, process and key skills. In addition to six psychosocial interventions that can by used by HCP’s to provide a more collaborative and flexible decision making process between the client and the HCP.

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Preferences of a Regional Cohort of Irish General Practitioners regarding Mental Health Immediate Discharge Summaries

Sean Creaven (Sligo/Leitrim Mental Health Service, HSE West)

Abstract

Aim: The aim of the study was to ascertain the preferences of a regional cohort of Irish GP’s regarding mental health immediate discharge summaries. Specifically, preferences regarding content, timeliness, and delivery method were examined.

Method: This quantitative study adopted a nonexperimental design of a descriptive survey, utilising a self-administered postal questionnaire. Descriptive statistics were predominantly utilised, with some inferential statistics used to compare results of questionnaires within the sample group.

Results: There were 50 respondents of 89 GP’s circulated (56%). All respondents wished to receive immediate discharge summaries, and found most information items currently in discharge summaries to be either essential or useful. Half (50%) preferred to receive summaries by post, and more than half (54%) wished to receive a phone call on discharge either routinely or to give urgent important information. Most respondents wished to receive discharge summaries either on day of discharge (44%) or within two days (44%). Almost half (46%) of respondents had no preference with regard to who should complete discharge summaries.

Conclusion: The use of a pro forma immediate discharge summary was universally supported by respondents, with broad agreement on the items of information required by GP’s when patients are discharged.

Recommendations include audit, training and supervision, research regarding a nurse-completed immediate discharge summary, and a larger scale Irish study.

The Use of Validation Therapy in Dementia Care

Mary Russell (Clare Mental Health Services)

Abstract

Background and Context: Dementia relates to the relentless decline in cognitive ability and is characterised by impairment in short and long term memory. Validation therapy is built on an empathetic attitude and a holistic view of individuals. Therefore, the role of the nurse is to focus on the emotional content of what is being said, attempting to recognise and confirm emotions, restore the persons self-esteem and understand the person in the content of the reality they perceive themselves to be at that moment. Aims and Objectives: Provide an overview of Validation therapy and its relevance to improving quality of life for dementia sufferers. Outline strategies involved in implementing validation therapy to practice. Discuss opportunities and challenges that present in implementing this approach to care.

Processes used: using non-threatening factual words, using art, music and reminiscence therapies, identifying and using the patients preferred sense and linking patient’s behaviour with met or unmet needs.

Evaluations and Outcomes: When one can step into the shoes of another human being shoes and see through their eyes, one can step into the World of disorientated people and understand the meaning of their sometimes unusual behaviour.

Conclusions and Implications: Quality of life in dementia care should be subjective and objective. The specific interventional needs of validation therapy bring together behavioural and psychotherapeutic methods to meet the needs of individuals with different stages of dementia. Validation therapy can enhance quality of life through increased communication between patients and staff, decreased agitation, increased family visits and fewer tranquilizing medications.  

HSE Dublin Mid-Leinster Laois Offaly Longford Westmeath Mental Health Services - Portfolio of Mental Health Assessment Tools

Margaret Daly (Mental Health Services, Laois Offaly Longford Westmeath)

Abstract

The Assessment Portfolio

Salutogenesis and recovery: removing the shackles of medicalisation

Tony Reid (Department of Nursing, Waterford Institute of Technology)

Abstract

The prevailing medical ideological paradigm which informs much of the current clinical and scientific study is pathogenic in orientation. While this view may have served mankind well, particularly over the last two centuries, and remains the leading evidence based paradigm, it has also created philosophical dominance and diagnostically reductionist thinking, particularly within the field of mental health. Antonovsky (1979) postulated that pathogenesis is by definition dichotomous, that is, either a person is sick (diseased) or well (non-diseased) and consequently this stance is contrary to an holistic, multidimensional philosophy of health and ultimately a recovery ethos. Pathogenic perspectives of health and illness are by definition, empirical and objective, and have often been viewed as the mainstay of illness management which minimises subjective human experiences; Salutogenic perspectives alternatively, embrace this subjective interpretation of human experience to provide meaning and movement. Sense of Coherence (SOC) is a core construct of the Salutogenic model described by Antonovsky (1979;1987) which emphasises the ability to stay healthy and functional despite the challenges of life. Salutogenic perspectives therefore are fundamental to the philosophy of recovery and Sense of Coherence as a core construct may be a useful means of providing a clearer understanding of what maintains health and function. Salutogenesis as a philosophical base, allows mental health professionals to promote a positive, hopeful, realistic and constructive approach to providing support, guidance and care for those experiencing mental health challenges. This poster presents a new synergy illuminating the potential and utility of salutogenics in transforming the human in recovery and social re-inclusion.

Antonovsky, A. (1979) Health, Stress and Coping: New perspectives on mental and physical well-being. San Francisco, Jossey-Bass Antonovsky, A. (1987) Unravelling the mystery of health: How people manage to stay well. San Francisco, Jossey-Bass

Role of Religion in Mental Health

Suriya Bakthakumar (Connolly Norman House, Area 6 Mental Health Services,Dublin ,Ireland)

Abstract

Comprehensive research evidences have identified significant links between religion and spirituality and mental health. Religion and spirituality have been measured by various spiritual practices. The term religion becoming reified into a fixed system of ideological commitments. Where as spirituality is increasingly used to refer to the personal, subjective side of religious experience. Most people experience spirituality within an organized religious context but fail to see the distinction between these phenomena (Marler & Hadaway, 2002).There is a gap between psychology and religion and spirituality that can be felt in the empirical arena. The possible reasons could be that religion and spirituality are less central and important to psychologists, religion and spirituality are mistakenly assumed to fall outside the scope of scientific study (Thomson, 1996), and are believed to necessarily recede during an age that reflects the rise of science and rational enlightenment (Barbour, 1990 , Hill et al., 2000). Religion and spirituality are not uniform processes but are complex variables involving cognitive, emotional, behavioral, interpersonal, and physiological dimensions. Knowing God, is the central function of religion. Perceived closeness to God has been significant predictor of mental and physical health. People who report a closer connection to God experience a number of health-related benefits like less depression and higher self-esteem (Maton, 1989b), less loneliness (Kirkpatrick,& Shillito, 1993), greater relational maturity (Hall & Edwards, 1996, 2002), and greater psychosocial competence (Pargament et al., 1988). Religion and spirituality frameworks can provide people with a sense of ultimate destinations in life. Empirical studies have provided some support for the theoretical connections between religion and spirituality framework and better health. Religious support can be a valuable source of self-esteem, information, companionship, and instrumental aid that buffers the effects of life stressors and exerts its own main effects and health benefits. (Cohen & Wills, 1985).Studies has shown that many people derive emotional and tangible support from their congregations. Religious support has been associated with more positive affect or life satisfaction (Fiala, Bjorck)The religious and spiritual life has it’s own struggles such as personal struggle tra individual struggle, and struggles with God (Exline, & Sanderson, 2000). According to most traditions, religious growth is essential to health. There is evidence that religion and spirituality are distinctive dimensions that add unique explanatory power to the prediction of physical and mental health. In sum, it is now known that religion is linked to physical and mental health. 

The development of evidence-based practice among Irish psychiatric nurses: Perceived sources of evidence, barriers, facilitators and skills to achieve evidence based practice

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Babu Lal Yadav (National Forensic Mental Health Services, Central Mental Hospital, Dundrum, Dublin)

Abstract

Introduction and Background: Despite much emphasis on the need to incorporate principles of evidence-based practice (EBP) in delivering evidence-based health care, the literature indicates that nurses are continually facing challenges to achieve evidence-based nursing (EBN) because of a number of barriers / influencing factors. The influencing factors of EBN are not fully understood or clearly identified in literature concerned to mental health nursing practice.

Aim and Objectives: This study examined a number of influencing factors in attainment of EBP and it was undertaken to determine different sources of practice knowledge, barriers and facilitators, and skills for implementing EBP among a national sample of Irish psychiatric nurses.

Design: Data were collected in a cross-sectional survey. Total seven hundred and fifty ‘Development of Evidence-Based Practice (Gerrish 2007)’ questionnaires were distributed through post to a randomly selected sample of registered psychiatric nurses. Survey was anonymous therefore; an exemption for full ethical review was sought by notifying to the concerned ethical committee. Only one hundred and sixty completed questionnaires were returned, representing a response rate of just 21.6%. Data were analysed using SPSS version 15.1.

Main Findings: The majority of survey respondents base their practice on information derived from patients, from their personal experience and from their colleague’s opinions in preference to published sources of evidence. Insufficient time to find and read research reports and insufficient resources to change practice were perceived as the greatest barriers. Practice development coordinators (PDC) were perceived as the most supportive to changing practice. The skill in which majority of the respondents had rated themselves as higher was concerned with using the Internet to search information and lowest was with concerned to using research evidence to change practice.

Conclusions: The findings suggest that Irish psychiatric nurses face similar challenges in attaining EBN as do their counterparts in general nursing.