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Improving the physical health of service users

MHNA Update Resource reviews News review Improving oral care Writing guidance

MENTAL HEALTH NURSING

DECEMBER 2012/JANUARY 2013 • VOL 32 • NUMBER 6

Improving the physical health of service users

MHNA Update Resource reviews News review Improving oral care Writing guidance

MENTAL HEALTH NURSING

DECEMBER 2012/JANUARY 2013 • VOL 32 • NUMBER 6

Editorial

Contents Mike Ramsay Lecturer in Nursing (Mental Health), School of Nursing & Midwifery, University of Dundee, and chair of editorial board for Mental Health Nursing

We need to give a welcome to Willis and develop education Lord Willis of Knaresborough was commissioned to independently explore pre-registration nurse education in April 2012, in response to some well-highlighted, high-profile incidences of poor nursing care in the UK. Some reports seemed to imply that poor quality undergraduate nursing preparation was a significant factor in engendering the negative practices that mark these cases. The Willis Commission (2012) report was published in November and can broadly be welcomed. Though not solely or directly focusing upon mental health nurse education, the findings are relevant to our discipline. The report identifies some key areas for education providers to consider. The commission noted prominently that nursing in the UK was a very self-aware discipline and could find no direct evidence of any shortcomings in nurse education to indicate this as a factor in poor care or any deterioration of standards, but did seek specific educational emphasis on the place of dignity in care delivery. The report further emphasises the importance of links between practice and education, and strengthening the use of service user involvement to enhance student learning. In welcoming the findings of the report, Mental Health Nurse Academics UK, a group that brings together representatives from all UK higher education institutions engaged in mental health nursing education and research, called for ‘specific funding for research into the impact of nurse education and nursing practice on patient outcomes… supported by financial help to embed patient/user involvement in nurse education and research with the aim of ensuring the consistent delivery of high quality, evidence-based nursing care.’ This report portrays hope in UK nurse education, but also points the way to developments and improvements that ensure a non-complacent view about clinical and educational standards is maintained, while augmented partnerships between education, practice and service users, in particular, become curricular cornerstones. MHN The Willis Commission report Quality with Compassion: The future of nursing education can be viewed at www. williscommission.org.uk/__data/assets/pdf_file/0006/484755/ Willis_Commission_2012.pdf

Editorial

03

We need to give a welcome to Willis and develop education

News

04

NMC fee rise branded ‘a curate’s egg’ by union • Detentions and community treatment orders on the increase • New mental health strategy for Wales launched • Rocking the halls for Mental Health Week • Miliband talks on mental health

Unite/MHNA update

07

A round-up of activity by professional officer Dave Munday

Meeting the physical health needs of mental health service users who are difficult to engage 08 and reach: a care study Lai Chan and Jean Kearns outline work to ensure people’s physical health needs are met

Speak Up! The gift of something tangible

11

Tony Gillam explains why this journal’s return to printed form is particulary welcome

Oral health – a key assessment skill for mental health nurses: a pilot evaluation of an educational intervention

12

Karen-Leigh Edward and colleagues outline the findings of a research project designed to develop and deliver an education package on oral health for mental health nurses

How to write for Mental Health Nursing

18

Are you thinking about writing for this journal? These guidelines will start you off in the right direction and help to ensure the process runs smoothly and successfully

Reflections

21

Resource reviews • Join Unite/MHNA – inside back cover/back cover

Cover image: Thinkstock EDITOR Phil Harris - [email protected] • 07717 438101 EDITORIAL BOARD • Mike Ramsay, chair of editorial board; lecturer in nursing (mental health), University of Dundee • Mandy Bancroft, director of widening participation and recruitment, University of the West of England • Steve Hemingway, senior lecturer in mental health, University of Huddersfield • Dan Hussey, student representative, University of Huddersfield • Alun Jones, adult psychotherapist, North Wales NHS Trust • Steve Jones, senior lecturer, Edgehill University, Faculty of Health, University Hospital Aintree, Liverpool • Donna Kemp, Care Programme Approach development manager, Leeds and York Partnerships NHS Foundation Trust • Dave Munday, professional officer, Health Sector, Unite the Union • David Rushforth, visiting research fellow, CCAWI, University of Lincoln PUBLISHER Ten Alps Creative on behalf of the Mental Health Nurses Association © MHNA 2012 ONE New Oxford Street, High Holborn, London WC1A 1NU ADVERTISING OFFICES Claire Barber, Ten Alps Creative, ONE New Oxford Street, High Holborn, London WC1A 1NU • [email protected] • 020 7878 2319 SUBSCRIPTIONS MHN is free to members of the Mental Health Nurses Association. Annual subscription (six issues/one volume) for non-members £72.45 / £108.75 Institutions (VAT and postage incl.) No part-volume orders accepted. Orders (cheques payable to MHNA) to: MHN subscriptions, Ten Alps Publishing (London division), Alliance Media Limited, Bournehall House, Bournehall Road, Bushey, Hertfordshire WD23 3YG • 020 8950 9117 • [email protected] ISSN 2043-7501 (Starting from Volume 30, Number 2, ISSN 2043-7051 replaced the print journal ISSN 1353-0283)

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Unite 4 our NHS Get up-to-date campaign information online at: www.unitetheunion.org/unite4ournhs

Union writes to members to protect Agenda for Change Members will soon receive a letter about the attempts – on a national level – to undo the Agenda for Change pay deal. The letter, entitled ‘We are ONE NHS – Defend national pay – Save Agenda for Change’, sets out the reasons why the pay system is so important. It says: ‘Your commitment and hard work are what makes the NHS what it is and why everyone who relies on it, cherish it. People work for the NHS because they care. They want to make patients well and to help people lead better, longer and healthier lives. ‘However, over the last two years, this unique ethos of our NHS has been eroded by this Government. • They dramatically cut the finances of the NHS by £20bn – and plan to cut more, leading to job losses and service cuts. • They passed the Health and Social Care Act in England, causing a massive, unnecessary and costly reorganisation of the NHS leading to wholesale fragmentation and privatisation of large swathes of the NHS. • They have cut back NHS services, closed wards and made The TUC rally in London on 20 October attracted thousands of marchers and supporters. The day culminated in a mass rally in Hyde Park, addressed by Labour leader Ed Miliband

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1000s of needed health workers redundant. • They are scaling back regulation, making the service less safe, but cheaper to sell. • Now they are attacking your terms and conditions both at a local level and through cuts to Agenda for Change nationally for staff in England and potentially across the four nations in the future if agreed by respective governments.’ It adds: ‘Now the NHS employers want to undermine national pay and cut Agenda for Change. The proposals will not only have huge implications for you, but will impact patient safety. In short, your trust boards and well paid chief executives want to cut your terms and conditions to make you cheap and “competitive” in a market which is all about selling off the NHS.’ Calling for unity and action, it adds: ‘Our history has taught us that when people stand up together in defence of their services, their jobs, their terms and conditions, united in purpose, they make a difference.’

Editorial

Contents Mike Ramsay Lecturer in Nursing (Mental Health), School of Nursing & Midwifery, University of Dundee, and chair of editorial board for Mental Health Nursing

We need to give a welcome to Willis and develop education Lord Willis of Knaresborough was commissioned to independently explore pre-registration nurse education in April 2012, in response to some well-highlighted, high-profile incidences of poor nursing care in the UK. Some reports seemed to imply that poor quality undergraduate nursing preparation was a significant factor in engendering the negative practices that mark these cases. The Willis Commission (2012) report was published in November and can broadly be welcomed. Though not solely or directly focusing upon mental health nurse education, the findings are relevant to our discipline. The report identifies some key areas for education providers to consider. The commission noted prominently that nursing in the UK was a very self-aware discipline and could find no direct evidence of any shortcomings in nurse education to indicate this as a factor in poor care or any deterioration of standards, but did seek specific educational emphasis on the place of dignity in care delivery. The report further emphasises the importance of links between practice and education, and strengthening the use of service user involvement to enhance student learning. In welcoming the findings of the report, Mental Health Nurse Academics UK, a group that brings together representatives from all UK higher education institutions engaged in mental health nursing education and research, called for ‘specific funding for research into the impact of nurse education and nursing practice on patient outcomes… supported by financial help to embed patient/user involvement in nurse education and research with the aim of ensuring the consistent delivery of high quality, evidence-based nursing care.’ This report portrays hope in UK nurse education, but also points the way to developments and improvements that ensure a non-complacent view about clinical and educational standards is maintained, while augmented partnerships between education, practice and service users, in particular, become curricular cornerstones. MHN The Willis Commission report Quality with Compassion: The future of nursing education can be viewed at www. williscommission.org.uk/__data/assets/pdf_file/0006/484755/ Willis_Commission_2012.pdf

Editorial

03

We need to give a welcome to Willis and develop education

News

04

NMC fee rise branded ‘a curate’s egg’ by union • Detentions and community treatment orders on the increase • New mental health strategy for Wales launched • Rocking the halls for Mental Health Week • Miliband talks on mental health

Unite/MHNA update

07

A round-up of activity by professional officer Dave Munday

Meeting the physical health needs of mental health service users who are difficult to engage 08 and reach: a care study Lai Chan and Jean Kearns outline work to ensure people’s physical health needs are met

Speak Up! The gift of something tangible

11

Tony Gillam explains why this journal’s return to printed form is particulary welcome

Oral health – a key assessment skill for mental health nurses: a pilot evaluation of an educational intervention

12

Karen-Leigh Edward and colleagues outline the findings of a research project designed to develop and deliver an education package on oral health for mental health nurses

How to write for Mental Health Nursing

18

Are you thinking about writing for this journal? These guidelines will start you off in the right direction and help to ensure the process runs smoothly and successfully

Reflections

21

Resource reviews • Join Unite/MHNA – inside back cover/back cover

Cover image: Thinkstock EDITOR Phil Harris - [email protected] • 07717 438101 EDITORIAL BOARD • Mike Ramsay, chair of editorial board; lecturer in nursing (mental health), University of Dundee • Mandy Bancroft, director of widening participation and recruitment, University of the West of England • Steve Hemingway, senior lecturer in mental health, University of Huddersfield • Dan Hussey, student representative, University of Huddersfield • Alun Jones, adult psychotherapist, North Wales NHS Trust • Steve Jones, senior lecturer, Edgehill University, Faculty of Health, University Hospital Aintree, Liverpool • Donna Kemp, Care Programme Approach development manager, Leeds and York Partnerships NHS Foundation Trust • Dave Munday, professional officer, Health Sector, Unite the Union • David Rushforth, visiting research fellow, CCAWI, University of Lincoln PUBLISHER Ten Alps Creative on behalf of the Mental Health Nurses Association © MHNA 2012 ONE New Oxford Street, High Holborn, London WC1A 1NU ADVERTISING OFFICES Claire Barber, Ten Alps Creative, ONE New Oxford Street, High Holborn, London WC1A 1NU • [email protected] • 020 7878 2319 SUBSCRIPTIONS MHN is free to members of the Mental Health Nurses Association. Annual subscription (six issues/one volume) for non-members £72.45 / £108.75 Institutions (VAT and postage incl.) No part-volume orders accepted. Orders (cheques payable to MHNA) to: MHN subscriptions, Ten Alps Publishing (London division), Alliance Media Limited, Bournehall House, Bournehall Road, Bushey, Hertfordshire WD23 3YG • 020 8950 9117 • [email protected] ISSN 2043-7501 (Starting from Volume 30, Number 2, ISSN 2043-7051 replaced the print journal ISSN 1353-0283)

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News review

The increase in the fees levied by the Nursing and Midwifery Council (NMC) to £100 a year for the next two years is ‘a curate’s egg’, according to Unite, the largest union in the country. Unite professional officer, Jane Beach said: ‘Unite will be monitoring the NMC’s financial situation very closely in the next two years to see that the NMC delivers its core regulatory functions within its new financial regime. ‘Our members, registered with the NMC, have not had a pay rise for two years because of the government’s austerity policies, so any increase – and this is 32% – is a blow to their static incomes.

‘Unite was vehemently against the NMC’s original proposal that would have seen a 58% hike to £120 a year. Our members, in a widespread consultation earlier this year, said that the fee should not be increased above £86 a year in line with the current rate of inflation. ‘So today’s announcement is a curate’s egg – it could have been worse, but should have been better. ‘We hope that the NMC will be more transparent in its dealings with its stakeholder organisations in the future.’ The NMC received a £20 million grant from the government to help it through its current

CJ Isherwood

NMC fee rise branded ‘a curate’s egg’ by union

financial crisis. Nurses, midwives and health visitors have to be registered with the NMC to be able to work in the health service – and the NMC is the regulatory body for their conduct.

Unite embraces the Mental Health Nurses Association; the Community Practitioners’ and Health Visitors’ Association; and the Society of Sexual Health Advisors.

Detentions and community treatment orders on the increase The number of detentions and Community Treatment Orders (CTOs) under the Mental Health Act increased last year, according to new figures from the Health and Social Care Information Centre (HSCIC). The figures come from the report Inpatients formally detained in hospitals under the Mental Health Act 1983, and patients subject to supervised community treatment, annual figures, England 2011/12. They showed the number of detentions in NHS and independent hospitals reached 48,600 last year, an increase of 2,300 (5%) on 2010/11. The report also showed the number of CTOs rose to 4,200 in 2011/12, an increase of 400 (10%) on the previous year. The report presents for the first time estimates of the number of place of safety orders made under Section 136 of The Act where the person was taken to a police custody suite.

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It shows there were an estimated 8,700 orders of this type made in 2011/12 – approximately one in three of reported Section 136 place of safety orders. The HSCIC estimates that the total number of Section 136 place of safety orders last year was at least 23,600, when this includes the 14,900 orders where the person was taken to hospital as a place of safety,. The report also shows that in 2011/12 there were: • 3,600 detentions in independent sector hospitals; an increase of 600 (21%) on the previous year (3,000), largely due to a 45% increase in detentions under Section 2 (a rise of 300 from the previous year). • 15,200 uses of place of safety orders to hospitals (considering both Section 136 and also Section 135, for which police custody data is not available); an increase of 800 (6%) on the

previous year (14,400). • 2,100 CTO recalls; an increase of 500 (30%) on the previous year (1,600). Approximately 70% of such recalls in 2011/12 ended in a revocation, compared to around 60% in the previous year. Detentions under the Mental Health Act are defined in the report as: • Detentions on admission to hospital under Part II (Sections 2 and 3) and Part III of the Mental Health Act 1983, and under previous legislation (Fifth Schedule) and other Acts; • Detentions subsequent to admission (uses of Part II Sections 2 and 3, following a change of legal status from Section 4, 5 or informal stay in hospital); • Detentions under Part II Sections 2 and 3 following the use of Section 136; • Detentions following a CTO revocation. HSCIC chief executive Tim Straughan said: ‘This is the first

time figures have been available showing the total number of detentions in police custody under the Mental Health Act of people in need of a place of safety. ‘Many people working in the area of mental health will be interested to know the extent to which police custody is being used and the fact that more than one in three place of safety orders is to police custody rather than a hospital.’

News review

New mental health strategy for Wales launched An all age, cross-Governmental strategy for mental health and wellbeing in Wales has been launched by the Minister for Health and Social Services, Lesley Griffiths. Together for Mental Health aims to combine existing policy, consolidate progress to date and place the Mental Health (Wales) Measure 2010 at the heart of strategy. The 10 year strategy is supported by an initial three-year delivery plan. The strategy seeks to improve both the outcomes for users of mental health services, their carers and their families, and the wellbeing and resilience of the wider population. It intends to place the service user at the centre of service delivery and has a focus on recovery and enablement ensuring people’s potential is maximised. It also sets out plans to improve attitudes towards mental health, reducing stigma and discrimination. The strategy is the first mental health and wellbeing strategy covering people of all ages and it aims for a seamless transition between youth and adult services. It also looks to help tackle needs such as housing, debt, financial and social issues, all of which can impact on people’s mental health and wellbeing. Together for Mental Health will be delivered in partnership with Health Boards, local authorities, the voluntary sector, service users, their carers and families. As part of the strategy, the Mental Health First Aid programme will continue helping people to recognise the signs and symptoms of someone with mental health problems. Targeted at raising mental health awareness, some key groups who have taken part

in this programme include the Ambulance Service, Welsh police forces and the Prison Service, JobcentrePlus, primary healthcare and social care, staff in further and higher education, support workers in a variety of settings and voluntary and community groups. The strategy is underpinned by age-inclusive outcomes, informed by service user and carer views expressed during the summer consultation. Welsh language and human rights are prominent in the strategy with specific outcomes identified for both. Minister for Health and Social Services Lesley Griffiths said: ‘Together for Mental Health is our commitment to do all we can to ensure we help people in Wales enjoy good mental health and wellbeing and those with mental ill-health are given all the support possible to recover and lead fulfilling lives. ‘The challenge facing us is to build on momentum and achieve the ambitions we have set ourselves in both the Programme for Government and Together for Health. Together for Mental Health sets out in clear and accessible terms a vision of mental health services fit for the 21st century.’ Bill Walden-Jones, Welsh chief executive of the Wales mental

health charity Hafal, said: ‘We anticipate that the strategy will be a positive step forward for mental health services in Wales. When it comes to delivering mental health services in Wales the new strategy and accompanying delivery plan, along with the Mental health measure, provide the greatest opportunity for change in a generation. ‘The last time we saw a significant shift in the way mental health services are delivered was when community care was introduced in the 1980s. ‘The problem with community care was that it left people stranded and neglected, receiving poor outreach services in the community. The mental health Measure and the new strategy have the potential to rectify this situation.’ Carina Edwards, Hafal’s

north Wales manager who has personal experience of mental illness, said: ‘We anticipate that the focus of the strategy will be on recovery. Our service users expect a strategy which gives them the maximum number of opportunities to work towards recovery of mental health and achieve full integration with the community. ‘But here’s the reality check: we know that while we have a new strategy there are no additional resources available for the delivery of mental health services. ‘The Welsh Government needs to stick to its promise that funding for mental health will be protected through ring fencing. The Government must also demand that non-mental health agencies such as housing, education, leisure services, etc., play their part in supporting people with a mental illness.’

Inside the new ten-year mental health strategy for Wales At the heart of the strategy is the Mental Health (Wales) Measure 2010, which places legal duties on health boards and local authorities to improve support for people with mental ill-health. The main themes are: • Promoting mental wellbeing and, where possible, preventing mental health problems developing.. • Establishing a new partnership with the public, centred on: improving information on mental health; increasing service user and carer involvement in decisions around their care; and changing attitudes to mental health by tackling stigma and discrimination. • Delivering a well designed, fully integrated network of care. This

will be based on the recovery and enablement of service users in order to live as fulfilled and independent a life as possible. • Addressing the range of factors in people’s lives which can affect mental health and wellbeing through care and treatment planning and joint-working across sectors. • Identifying how to implement the strategy. The strategy is focused around six high-level outcomes and supported by a delivery plan. This sets out the actions the Welsh Government and partner organisations will undertake to make the strategy’s vision a reality. A new national Mental Health Partnership Board will oversee delivery of the strategy.

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News review

Rocking the halls for Mental Health Week Rock the Halls was a music and entertainment night held on Friday 12 October in the Rothes Halls, Glenrothes as part of Mental Health Week to raise awareness of mental health issues and to tackle stigma. Groups and individual artists from all over Fife took part, with the acts primarily consisting of patients/service users (past or present) or people who work within mental health care settings. A prominent feature of the event was the high quality of the performances and the enthusiasm of all acts throughout the night, many of which were at varied stages of their recovery journey. The individual difficulties and disabilities appeared to fade when they went on stage and preformed alongside their fellow musicians. This not only heightened the sense of achievement of participants but was humbling to watch. The level of enjoyment was evident by the response of the audience, who not only filled the hall but also gave a rapturous applause after each performance.

A highlight of the night for me was the emotive performances by two individuals, who happily shared their difficulties and diagnoses with the audience. One performed a few songs he had written himself and another dedicated his emotional song to others less fortunate than themselves, throughout his performance the room so quiet you could hear a pin drop. Each performer played a few songs which varied from old classics to today’s chart songs. The headline acts of the night were The Painted Ladies and The Swank, the former being an all-female contemporary rock group who were vividly dressed in bright costumes, the other an all-male group who blasted out a number of rock ballads much to the enjoyment of a significant number of the audience who were clearly followers and supporters of their music. Danielle Payne Mental health nursing student University of Dundee (Fife Campus)

The Swank, with guest performer Dr Bob (second left)

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Miliband talks on mental health Labour party leader Ed Miliband has made a major speech on mental health, calling it It is ‘the biggest unaddressed health challenge of our age’, and challenging the way society treats mental health. In the speech, which was delivered at the Royal College of Psychiatrists in London, Mr Miliband criticised celebrities who are intolerant of people with mental health problems. He said: ‘Fighting the taboo is the first thing we need to do. People like Marcus Trescothick, Stephen Fry, Fiona Phillips, Labour’s Alastair Campbell and Kevan Jones, and politicians from other parties, like Charles Walker, have all been exceptionally brave in sharing their own painful stories with our country. And some newspapers from the Sunday Express and Observer have tried to break the taboo and they too are to be congratulated. ‘But far too often there is scepticism and abuse. Abuse that reinforces the taboo. And it’s not just casual name calling in the streets or the school playground. ‘There are still people who abuse the privilege of their celebrity to insult, demean and belittle others. Such as when Janet Street-Porter in a shocking article says that depression is “the latest musthave accessory” promoted by the “misery movement”. ‘And Jeremy Clarkson, who may have at least acknowledged the tragedy of people who end their own lives, goes on to call them “Johnny Suicides” whose bodies should be left on train tracks rather than delay journeys. ‘It is attitudes like these that reinforce the stigma that blights millions of people’s lives. And holds our country back. ‘The fight against racism, against sexism and against homophobia, made the acceptable,

unacceptable. So we should join the fight against this intolerance. ‘It is wrong. It costs Britain dear. And it has to change.’ Mr Miliband said he would rewrite the NHS Constitution and create for citizens a new right – for the first time – to psychological therapies that help people recover from conditions like anxiety and depression. There is money allocated in the NHS budget for this purpose, but it is not always being spent on what it was intended for. He added that talking therapies can help people and save money, so they must be a NHS priority, and that there should be more mental health specialists working in teams with GPs, nurses and carers. He said: ‘We need to look at extending personal health budgets that enable patients to select the best combination of services and treatments for themselves. Both mental and physical. ‘We also need all health professionals to see promoting good mental health and spotting signs of mental ill-health as part of what they do. So we should ensure that the training of doctors, nurses and all professional staff who work in the NHS includes mental health.’ Jeremy Clarkson later hit back at the Labour leader on Twitter, saying: ‘I have read what Miliband said. And seriously, I’m not sure he’s right in the head.’ Marjorie Wallace of SANE, said: ‘We hope that, with this head of steam from the Opposition, we will see a renewed attack on the ways psychiatric services are being cut and the care they deliver spread so thinly that they leave many thousands to struggle without help. ‘It is not just the negative taboo reinforced by the celebrities he quotes, it has been the traditional apathy that sets in where mental illness is involved.’

MHNA Update

Unite/MHNA update Dave Munday

2013 – where did that come from? The bimonthly schedule of Mental Health Nursing means that this is both my last professional officer’s update of 2012 and the first of 2013. There is a famous Japanese curse that says: ‘may you live in interesting times’ – to downplay what is going on at the moment, we certainly have been ‘cursed’ with some interesting times. As you will have seen on page 2 of this issue, the health sector has written out to all of our 100,000 members to give a briefing on what is happening with negotiations on Agenda for Change in England. I am not going to repeat that in this report, but as I know, our members have already felt the effects of the coalition’s austerity both in their lives outside of work and in the work they do on a daily basis that makes a difference to so many people in our society. I am sure that 2013 will also be a difficult year for many people, both for our members who will have to fight against short-sighted decisions (about services and jobs, pay, and terms and conditions) and those in our society who rely on your services to survive each month. As part of the resistance to the coalition’s austerity I, along with many thousands of others, attended the 20 October march and rally in London. It was great to meet many of our health sector members

including some MHNA members. I managed to get a few photos from the day including our Unite Health Sector banner as it passed parliament, the Department of Health and Downing Street. You can see the images on the new Unite in Health Facebook page at www.facebook.com/ UniteInHealth (this joins our already established MHNA page at hwww. facebook.com/Unite_MHNA). I have had the opportunity to hear our general secretary, Len McCluskey, speak on a few occasions over the last month. One was at the London rally, where he spoke about Unite’s opposition to the ongoing carveup of the NHS. The second was at the Unite/ Community Practitioners’ and Health Visitors’ Association conference in Brighton. Here he went into great detail about the coalition’s arguments behind cutting pay, terms and conditions in public services, and took these arguments apart. Again, this speech has been posted on the Facebook page so you can find out what he had to say. Are you thinking? In my last update I gave some brief feedback about an online training session that we offered and was excellently delivered by Mike Ramsay, chair of the Mental Health Nursing editorial board. I hope you will have all seen the email that I sent out recently, which launched the next

yameen9000

Professional officer Unite the Union (in the health sector) [email protected]

development in this added benefit to members. Following extensive trailing with CPHVA members we have now launched Unite In Health Thinking Thursday (#UiHTT). This is a series of training sessions, held at least once a month, which our members can access free of charge. Some will be targeted at specific Unite In Health membership groups, while others will be targeted at Unite In Health representatives, but many will be applicable for all members. All you need is your membership number, a phone and an internet connection. You still need the time to devote to the session (not easy, I know), but at least it cuts down on your requirement to travel to training. The sessions will also be recorded so members can always ‘Think Again’ whenever they want. Another development that we are trialing at the moment is #CPHVACPD. This is an online tool for members where they can

take part in modules, answer multiple-choice questions, complete some reflection and then gain certificates for the time. These can then be stored online or printed and downloaded. The system also allows members to add their professional development activities that haven’t been completed on the system, so they can build an online portfolio. Once we have worked out all the kinks, I am hoping to bring this to you as #MHNACPD in the new year. This is another added benefit included in your membership. Finally, I would like to take the opportunity to wish everyone a merry Christmas and a happy new year, and make a special mention of the outgoing National Professional Committee members, the members of the Mental Health Nursing editorial board and all those colleagues who have helped me in supporting our members during 2012. See you next year. MHN

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Care study

Meeting the physical health needs of mental health service users who are difficult to engage and reach: a care study Lai Chan and Jean Kearns outline work to ensure people’s physical health needs are met

Lai Chan Associate head, CPD and Postgraduate Studies, Edge Hill University Correspondence: [email protected] Jean Kearns Community mental health nurse, Newhall Community Mental Health Team Abstract Within a local assertive outreach team it was recognised that care coordinators are best placed to work collaboratively with service users and the primary care service towards mental and physical health wellbeing. The team was able to identify which service users had not attended for their annual physical health checks, adopt a client-centred approach to undertaking physical health observations and communicate this to the relevant GP practice by means of a proforma. Care coordinators offered service users the opportunity to discuss any physical health issues to promote wellbeing. This gave care coordinators the opportunity to communicate with GPs and support collaborative working between primary health care and secondary mental health care. Care coordinators could also offer practical and psychological support to attend appointments with the practice nurses or GP. Key words Physical health, mental health, hard-toreach service users Reference Chan L and Kearns J. (2012) Meeting the physical health needs of mental health service users who are difficult to engage and reach: a care study. Mental Health Nursing 32(6): 8-10.

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Introduction In the last two decades, protection and promotion of the physical health of people with severe mental illness has been subject to public health and ethical debate worldwide (Maj, 2009). There is extensive research evidence to suggest that the prevalence of many physical diseases is higher in persons with severe mental illness such as schizophrenia, schizoaffective disorder and bipolar disorder than in the general population (Harris and Barraclough, 1998; Osborn, 2001; De Hert el al, 2009). There is increasing evidence that disparities in healthcare also contribute to poor physical health outcomes for people with severe mental illness that attributed to a number of factors which include systemic issues such as the separation of mental health care services from other medical services and healthcare provider issues such as stigma (Kisely and Lawrence, 2010). Despite evidence to suggest that patients with severe mental illness have frequent contact with primary care services (Phelan, 2001), their physical health is rarely monitored at these appointments. Patients are seen for approximately eight minutes, which may prove difficult for the GP to fully assess the problem (Kendrick, 1996). Diagnostic overshadowing may occur within the consultation, which is described as the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to under diagnosis and mistreatment of physical conditions (Jones et al, 2008). Prince et al (2007) propose that health services are not provided equitably to people

with mental disorder and state that mental health awareness needs to be integrated into all aspects of health and social policy and delivery of primary and secondary general health care – hence there is a great need for mental health practitioners to be proactive and promote good physical health as part of recovery. A local audit revealed that assertive outreach’s service users’ uptake of the 12 month annual physical health checks from primary care was alarmingly low. A total of 120 service users registered with local GP practices were identified, 70 of which were under the local assertive outreach team. Out of this group, only 35 service users had been invited for their annual physical check-up and just 22 had taken up the offer and attended. For the other 35 service users, it was unknown whether they have been invited or they had been registered as a severe mental illness patient within their GP practice. It was also found that 48 of the 70 patients had visited their GP frequently for review of medication or for repeat prescriptions. These findings are similar to Phelan’s study (2001). The audit provided the evidence for the local assertive outreach team to make plans to ensure their clients are given every opportunity to have their physical health assessed regularly as part of their recovery and social inclusion efforts. The team’s plan was: 1. To design a proforma to record patient information, which could be retained for audit. 2. Each care coordinator to carry out a basic physical health screening with each

Care study patient to include records of their height, weight, body mass index (BMI) and blood pressure, and to discuss smoking, illicit substance use, physical exercise, diet and side-effects of anti-psychotic medication. This information would then be added to the trust’s electronic patient information system to support meeting its Commissioning for Quality and Innovation (CQUIN) target, which is a performance indicator for the trust. The information would then be added to the care plan to meet National Institute for Health and Clinical Excellence (2009) recommendations as part of the Care Programme Approach. This information could also be used for audit. 3. To communicate the results of the screening to the appropriate primary care practice. 4. To provide physical activities if a patient expresses an interest in addressing physical health issues. The project took place at an assertive outreach team between September 2011 to May 2012, in Merseycare NHS Trust. Addressing staff concerns A focus group was formed to assist this process and provide an opportunity for staff to air their individual thoughts. During the focus group, several staff identified this as an opportunity to develop knowledge and skills around physical health. They believed that helping service users to acknowledge and engage in health promoting activities would enhance collaborative working – for example, recording observations in the patient’s home and accompanying them to appointments. There was also an opportunity for the team to help to secure further funding for the

team’s activities (such as a football group) by having evidence that the team has shown commitment to improving the physical health of the service users. This was a positive reaction by the team, which helped to ensure a shared vision and build momentum. There were some worries expressed that the workload of staff would increase and that some staff may not have skills to use the equipment or know what to do with the results of their observations. However, the team solved this by offering peer mentoring to staff who were not familiar with the equipment, while mandatory training on using the equipment was planned to ensure validity and reliability of everyone’s competencies. It was identified that a local care pathway would need to be designed to ensure a standard approach when risks are identified. Some equipment was required to undertake the basic observations. This included a height wand, electronic/battery operated scales to measure weight and BMI, and blood pressure monitoring equipment. Instruction on how to use the equipment was delivered by colleagues in the local blood monitoring clinic, who had been using the equipment for over 12 months. This was then disseminated to team members on a one-to-one basis and demonstrations were given at the weekly clinical team meetings. Interventions and outcomes The initial work was to design a proforma that capture all the information required for a physical assessment (see Box 1). The aim of the proforma was to be a tool that the care coordinator could use to

References

of mental disorder. British Journal of Psychiatry 173:

Balfour M and Clarke C. (2001) Searching for sustainable

11-53.

change. Journal of Clinical Nursing 10: 44-50. Bowers B. (2011) Managing change by empowering Staff. Nursing Times 107: 32-3. Bradshaw T, Lovell K, Harris N. (2005) Healthy living interventions and schizophrenia: a systematic review. Journal of Advanced Nursing 49: 634-54. DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei

Holbeche L. (2006) Understanding Change: Theory, implementation and success. Elsevier: Oxford. Jones S, Howard L, Thornicroft G. (2008) ‘Diagnostic overshadowing’: worse physical healthcare for people with mental illness. Acta Psychiatrica Scandinavica 118(3): 169-71. Kendrick T. (1996) Cardiovascular and respiratory risk factors and symptoms among general practice patients with long

DM, Newcomer JW, Uwakwe R, Leucht S. (2011) Physical

term mental illness. British Medical Journal 169: 733-9.

illness in patients with Severe mental disorders. II. Barriers

Kisely S and Lawrence D. (2010) Inequalities in health care

to care, monitoring and treatment guidelines, plus

provision for people with severe mental illness. Journal of

recommendations at the system and individual level. World

Psychopharmacology 24: 61-8.

Psychiatry 10: 138-51. Harris EC and Barraclough B. (1998) Excess mortality

Maj M. (2009) Physical health care in persons with severe mental illness: a public health and ethical priority. World

communicate recordings of observations to the relevant GP practice, and alert them when there were potential physical health problems. This would also ensure that staff did not seek to develop their own methods of collating and communicating information. The proforma would identify if service users are considering and taking action on healthy living. It could also be retained for future audit. Over the next couple of weeks five staff members used opportunities with service users to begin to record their observations onto the proforma and pilot the project. One support worker in the team used the football group session to record baseline observations, and found that this generated a group discussion on healthy eating and smoking cessation. The support worker also took a request from one service user for information on the side-effects of his antipsychotic medication. As the work progressed, another member of the team reported that his patient reported feeling able to discuss his fears and anxieties about his physical health with his care coordinator – something he said he avoided with the GP practice nurse and his GP. This was because the service user had a trusting relationship with the coordinator and so did not feel embarrassed discussing personal issues. However, he said he would be prepared to consult the GP with the support of his care coordinator. He said the support would prevent him feeling that the GP only saw him as being ‘mentally ill’. This perception is also identified in the study by Phelan et al (2001). The physical assessment showed that several service users had untreated diabetes

Psychiatry 3(1): 1-2. National Institute for Clinical Excellence. (2009) Core interventions in the treatment and management of schizophrenia. Update. NICE: London. Osborn DPJ. (2001) The poor physical health of people with mental illness. Western Journal of Medicine 175(5): 329-2. Phelan M, Morrison S, Stradins L. (2001) Physical health of people with severe mental illness. British Medical Journal 322: 443-4. Prince M, Livingston G, Katona C. (2007) Equitable health service: mental health care for elderly in low income counties, a health systems approach. World Psychiatry 6(1): 5-13. Shanley C. (2007) Management of change for nurses: lessons from the discipline of organizational studies. Journal of Nursing Management 15: 538-6.

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Care study (type I and type II). This has resulted in further collaborative working between the GP, district nurse, practice nurse and the care coordinator. One particular service user was found to have dangerously high blood pressure with diabetic symptoms that required urgent hospitalisation. If the assessment had not occurred, this could have serious consequences for the service user and the organisation. The team noted that the majority of the service users suffering with undiagnosed physical health problems were living on their own. They appeared to received very limited or indeed no family support – all display elements of self-neglect. This suggests that it

is important for mental health practitioners to be more vigilant in their holistic assessment when working with clients who are isolated and may live alone. Currently the organisation is going for major reconfigurations of their community services, and the assertive outreach team has been integrated into the community mental health teams. However, the physical health monitoring project and the proforma has been recognised by senior management as good practice. One of the authors continues to lead on this project in her current community mental health team. The organisation is planning for the proforma to be made electronically available on the patient system as part of

Box 1. Physical health proforma Name:

_______________________________________________________________

Care coordinator:

_______________________________________________________________

GP:

_______________________________________________________________



_______________________________________________________________

Baseline observations: Date

B.P

Weight

Height

BMI

Week 2

Any action required?

Date Week 3

Any action required?

Date Week 4

Any action required?

Date Week 5

Any action required?

Date Week 6

Any action required?

Date Have you discussed health promotion?

YES

[

]

NO

[

]

[

]

If YES, What issues did you discuss? (please tick) Smoking [

]

Alcohol

[

]

Diet

]

Physical activity

[

]

[

Illicit substances

Notes for further intervention: Please refer to Assertive Outreach Team Physical Health Resource file

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the commissioning for quality and innovation (CQUIN) payment framework. Since the start of this project, all the good practice has been fed back to the trust’s Physical Health Care Group, which meets every month and involves community team representatives, service managers, medical representatives and development leads. Conclusion Research has informed this development, and the team has embraced the change positively. However, the practical demands of healthcare mean that staff work in constantly changing environments, and they must continually adapt to different demands, government policies and other innovations (Bowers, 2010). To bring about sustainable change staff must identify, embrace and value new ways of working (Balfour and Clarke, 2006), hence the need for a standardised approach, and the usage of the proforma for documentation and audit trail. We believe that the practitioners and service users alike have and will continue to benefit from this initiative and have improved level of engagement. We also believe that leadership has played a central role in pushing the staff out of their comfort zone, and helped to assist the team’s vision of redesigning existing service to support service users in their physical health needs. Bradshaw et al (2005) advocate specific roles/posts to address physical health needs, however with service users with severe mental illness who are difficult to engage or difficult to reach it could be argued that an assertive outreach team is in the best position to support and promote physical health wellbeing, because of the established therapeutic relationship with the service user and the collaboration with primary care. Most changes in practice fail because nurses are not supported and empowered to adjust emotionally to new ways of working (Holbeche, 2006). Therefore any change must be planned, and involve and support staff to ensure its sustainability, as advocated by Shanley (2007). In this project we had the necessary support from management, and a focus group allowed staff to voice their concerns and individual needs were addressed before the project was fully operational. MHN

Speak Up!

The gift of something tangible Tony Gillam explains why this journal’s return to printed form is particulary welcome You are holding in your hand a copy of Mental Health Nursing -- and it’s a small miracle. For so long consigned to the virtual world of the e-zine, once again MHNA members can look forward to a real-life magazine. Does anyone care? Well, yes, actually. I do. I’m delighted that Mental Health Nursing is back in print and I’ll tell you why by answering three questions. 1. What’s wrong with an onlineonly magazine? I’ll begin with a confession. I went from being a regular reader of Mental Health Nursing to being a non-reader. I’ll admit that I’m sometimes a late adopter of new technology but I’m far from being a Luddite and yet I’ve never bothered to log onto the website and access the online journal. How many of us could truly be fussed to go to the Mental Health Nursing home page, click on ‘sectors’ followed by ‘health sector’, then choose ‘health sector professional groups’ followed by ‘MHN’ to get to the journal’s homepage, before clicking on the link for Mental Health Nursing and finally logging in with a membership number and a password? NHS staff are well-used to navigating unintuitive computer systems but we ought to be able to expect resources provided by our professional association to be

more user-friendly. The simple truth is that an online journal is invisible unless you go to the trouble of logging on and viewing it. Out of sight is out of mind, whereas a real-life magazine dropping through your letterbox is just asking to be flicked through, at least, if not read avidly from cover to cover. 2. Aren’t there enough magazines and journals for mental health nurses? Well, yes and no. In my three decades of nursing -- and of reading and contributing to the nursing press -- I’ve seen a lot of publications come and go. After cutting my journalistic teeth book reviewing for Nursing Standard and Nursing Times, one of my first full-length articles was published in the small but beautiful Community Psychiatric Nurses Journal -- forerunner of Mental Health Nursing. Then, there was Psychiatric Care, the Journal of Primary Care Mental Health, Mental Health Care which became Mental Health Today, Mental Health Practice, The Mental Health Review, the British Journal of Wellbeing (which has recently relaunched itself as the British Journal of Mental Health Nursing) and the more scholarly Journal of Psychiatric and Mental Health Nursing, Perspectives in Psychiatric Care and the International Journal

of Mental Health Nursing (with apologies to any titles that I may have missed out.) But for mental health nurses wanting to share and gather ideas and insights, the reality is a shrinking economy of publications; Mental Health Practice is now published 10 rather than 12 months of the year while the monthly British Journal of Wellbeing metamorphosed into the quarterly British Journal of Mental Health Nursing. The digital revolution, market forces and the recession have had a massive impact on healthcare, education, academia, advertising and marketing, publishing and journalism. At the same time, the identity of mental health nursing is threatened by multidisciplinary blurring and role overlap. In this climate, it’s a promising sign -- if not quite a ‘green shoot of recovery’ – that one professional organisation (the MHNA) is giving back to its members the gift of a tangible professional journal. It represents an invaluable service -a forum for collegiate support and development. 3. Will Mental Health Nursing survive? The survival of any magazine or journal depends on its readers and its subscribers (and, in many cases, its advertisers). Of course, the health and resilience of Mental Health Nursing

education special Interviews for university Challenging behaviour on a placement Reflections on the first year of university Social media benefits Fitness to practise MHNA Update Resource reviews

Mental HealtH nursing

AUgUSt/SepteMbeR 2011 • VOLUMe 31 • NUMbeR 4

depends to a large extent on the health of the MHNA. The journal cannot survive without a loyal and growing body of MHNA members but the fact is that a useful, attractive, informative and readable journal is a great way of recruiting and retaining members. It also needs to turn readers into writers, which means nurses being prepared to reflect on their practice and to communicate with their fellow nurses, to demonstrate – to use an unfashionable word -- solidarity with their mental health nursing colleagues so that the association, the journal and the profession can not only survive but thrive. MHN Tony Gillam is clinical manager of Worcestershire Early Intervention Service, a visiting lecturer at the University of Worcester and the author of Reflections on Community Psychiatric Nursing (published by Routledge)

Write for MHN!

SPEAK UP!

Speak up! is an informal opportunity to for you to write for Mental Health Nursing about anything relevant to you and your fellow members. It can be subjective, serious or light-hearted, and you won’t be expected to provide references. If you have something to say, then just contact the editor to discuss style and deadlines. Email [email protected]

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Physical health

Oral health – a key assessment skill for mental health nurses: a pilot evaluation of an educational intervention Karen-Leigh Edward and colleagues outline the findings of a research project designed to develop and deliver an education package on oral health for mental health nurses Karen-Leigh Edward Director/chair, St Vincents Private Hospital (Melbourne), Nursing Research Unit, and associate professor of nursing research, Faculty of Health Sciences, Australian Catholic University, Australia Correspondence: karen-leigh.edward@ acu.edu.au Steve Hemingway Senior lecturer, mental health, University of Huddersfield John Stephenson Senior lecturer in health and biomedical statistics, School of Human and Health Sciences, University of Huddersfield Abstract This project aimed to develop and deliver an evidence-based education package with a physical and mental health focus to clinicians and other healthcare workers in the mental health and disability settings, focused on oral health. Mental health and learning disability nurses attended the training and their views were obtained. Participants were inspired by the workshop and felt oral health should be part of their routine practice. Targeting this area in physical health can make a major contribution to interventions available to improve the physical health of service users. Key words Oral health, physical health, xerostomia Reference Edward KL, Hemingway S, Stephenson J. (2012) Oral health a key assessment skill for mental health nurses: a pilot evaluation of an educational intervention. Mental Health Nursing 32(6): 12-16.

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Introduction Poor oral hygiene can lead to an increased chance of gum disease, decay and toothlessness. Associated inflammatory conditions due to poor oral health can also increase morbidity and mortality, although in routine practice this is considered nonessential nursing care in some areas of health (Berry et al, 2007). Oral care for service users can minimise the negative oral effects from such conditions as immuno-suppression, cancer, dehydration and diabetes. Oral care can reduce the negative impact of the oral side-effects of commonly used psychoactive medications such as dry mouth (xerostomia) or increased salivation experienced as an effect of antipsychotic medications. Many medications used in mental health and disability are xerogenic (can cause dry mouth) and lead to poor oral health. Xerostomia is commonly associated with the onset of other oral symptoms (such as taste disturbance and ulcers), and affects oral function (chewing, eating, speaking). It also increases the risk of caries, ulcers, periodontis and oral/systemic infections. This paper shows the preliminary findings of the oral health education component of a physical/mental health workshop series delivered in 2012 to clinicians and students who either work in (or are interested in) mental health and disability services. The importance of the findings of this phase of the physical/mental health education project is to provide both the novice and experienced nurse with additional knowledge to inform their practice.

Literature search A search of literature was undertaken using CINAHL, MEDLINE, PsycARTICLES, and PsycINFO. The search used the search terms oral health AND nursing AND mental illness AND published date 2005 to 2010. Abstracts were reviewed and selected. Earlier works were included if the researchers thought their content could add to the presentation of the findings. Additional review of the literature was manually undertaken through university library textbooks. Mental health and physical health Individuals with mental illness have an increased risk of physical health problems when compared with the general population (Robson and Gray, 2007). In Australia the second National Survey of Mental Health and Wellbeing was conducted recently by the Australian Bureau of Statistics (ABS). This revealed that mental health disorders were more frequent among people with one of the chronic physical conditions such as diabetes, cardiovascular disease and cancer than for those without them (28% compared with 18%) (Australian Institute of Health and Welfare, 2010). This difference was higher for females than for males. In the UK it is estimated that individuals with mental illness die between 10 and 15 years earlier than the general population (Farnham et al, 1999; Newman and Bland, 1991). Research from the US indicates that this difference is as much as 25 years (Parks et al, 2006). An issue of concern is that the majority of research in relation to mortality and morbidity

Physical health is concerned with service users/clients who are in receipt of care from mental health services, and yet chronic physical health conditions are going unnoticed even in the context of mental health or disability care (Nash, 2010). People who experience mental illness are more likely to suffer from long-term physical conditions with associated morbidity risk such as diabetes, respiratory problems, infection and cancer (Dixon et al, 1999); heart disease (Department of Health, 2006); stroke and other neurological disorders (DRC, 2005); and HIV (Couros et al, 1999). Additionally, the causes of physical health related concerns in those who experience mental disorder or disability are diverse – whether physiologically (Dinan et al, 2004; Gough and Peveler, 2004), psychological (Nocon, 2004), sociological determinants (Samele, 2004; Phelan et al, 2001; Sherr, 1998), or as a lifestyle choice (Department of Health, 2011; Nash, 2010). Up to 90% of people who experience mental disorders receive medication management as part of their treatment regime. However, psychoactive drugs can impact the physical condition of the individual and this phenomenon requires vigilant management by the clinician involved in the person’s care. For example, the tricyclic antidepressant (TCA) medications, which although used less today, were widely used to treat depression and they can bring about unwanted effects, commonly xerostomia. The xerogenic impact of selective serotonin reuptake inhibitors (SSRIs) is less than that seen in the TCAs. Xerostomia occurs in 14% people taking SSRIs and in 45% of people taking TCAs. Common oral health manifestations of major depression include dental caries, poor oral hygiene, xerostomia, toothlessness, periodontal disease, and poor nutrition and diet. Lithium, another medication used for mood disorders and commonly used in people diagnosed with bipolar affective disorder, also causes xerostomia as a common side-effect. Oral manifestations of the manic phase of bipolar affective disorder include worn down (abraded) oral mucosa and cervical tooth abrasion (due to over vigorous brushing or use of dental floss). Anticholinergic effects, including

xerostomia, are also among the unwanted effects of antipsychotic medications, with up to 44% of service users experiencing this effect (more commonly noted in olanzapine and quetiapine). The prevalence of substance use and early psychosis reveal high rates of between 39% and 51%, and anecdotal evidence suggests these figures are higher. The oral implications of alcoholism and substance misuse include poor oral hygiene, xerostomia (due to atrophy of salivary glands), higher incidence of oral cancer (due to heavy smoking), candidiasis (due to poor nutrition), dental neglect, dental attrition (bruxism), impaired wound healing (caused by liver damage), bleeding tendency (due to liver damage), ‘meth mouth’ from methamphetamine use, and facial and oral injuries due to trauma (such as falling). Physical health screening – a mental health care gap The ability to screen for physiological health conditions is of fundamental importance to mental health nursing practice, yet there is still evidence that such conditions go largely unnoticed, and if identified are often poorly managed (Phelan et al, 2001; Edward et al, 2011). The seriousness of physical symptoms being identified as psychosomatic cannot be underestimated when one considers the number of people with severe and enduring mental illness being at risk of and suffering from long-term physiological conditions – termed ‘diagnostic overshadowing’ (Nocon, 2004). Further studies have also demonstrated that individuals who experience mental illness are less likely to be offered screening that the general population would expect routinely, such as cholesterol checks, urine or weight checks, and opportunistic advice regarding smoking cessation (Phelan et al, 2001; Organ et al, 2010). Jordan (2000) and Edward et al (2011) posit that the physical health needs of the patient diagnosed with a serious mental illness is a ‘care gap’ not being effectively met by neither primary care nor secondary mental health services. The project – the physical/registered and student nurse workshop series Alongside colleagues from South West Yorkshire Partnership Foundation Trust

(SWYPFT), the researchers applied to the Yorkshire and Humber Strategic Health Authority Clinical Skills Network and secured a grant to produce some interactive education and training packages that were specifically applied to the learning disability and mental health settings. The first wave of the education packages included epilepsy, oral health, intramuscular injections, diabetes, assessment using the health improvement profile, and wound care. Topic selection was based on feedback from clinicians. Collaboration Building on previous collaborations in physical health generally and incorporating the concepts of medicine management education and training for mental health nurses, the key stakeholders that were involved the development of the education package in this collaborative project included the trust, university staff and mental health and disability service users. The approach to developing the education used here complements and builds upon the ‘stepped approach’ to medicines management training developed by Hemingway and colleagues (Hemingway et al, 2010). Such collaboration is identified as a key determinant to achieving positive service user outcomes (Prowse and Heath, 2005). Project aim and objective The aim of this project was to develop and deliver an evidence-based education package with a physical and mental health focus to clinicians and other healthcare workers in the disability and mental health settings. In addressing a potential knowledge and skill deficit the objective of the project was to build capacity of practitioners to assess and plan appropriate physical health interventions for people diagnosed with a mental illness and/or learning disability. Methods Participants and recruitment A study day on oral health was advertised regionally for nurses to access as part of continuing professional development for practising clinicians and to university students as part of their undergraduate programme. There were spaces for open-ended comments and these were analysed using content analysis.

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Physical health Design A pre- and post-test design was used to evaluate this phase of the project. Instruments First the workshop attendees were asked to complete a pre-workshop questionnaire quiz regarding their current knowledge of oral health using a multiple-choice format. This was repeated after the workshop, together with a post-evaluation of the workshop content, materials and delivery, using a mixed method questionnaire with items rated in a Likert design and with spaces for open-ended comments. Ethics Permission to undertake the study was granted by the School of Health and Human Sciences Research Ethics Panel. Confidentiality was maintained throughout the project and only aggregated data is presented. Data analysis Quantitative analysis This was conducted on 23 questionnaires submitted before the training programme and 12 submitted after the intervention. Although the same group of individuals were involved in both cases, it was not possible to match the ‘before’ and ‘after’ questionnaires, or to definitively identify all respondents as either nurses or qualified practitioners. Each student was assessed on their response to 10 equally weighted five-point Likert-style multiple choice questions relating to their agreement with statements relating to oral health and its treatment. The students’ overall scores were obtained by summing the marks allocated to each response: hence a maximum of 50 and a minimum of 10 marks could be obtained, with a high score indicating a student with a good self-reported level of understanding. Qualitative analysis Content analysis of the open-ended questions was undertaken using a process outlined by Newell and Burnard (2006). At first, two authors read and re-read the written responses in order to be familiar with the text, ideas and themes. Subsequently, they agreed on emerging themes. According to Newell and Burnard (2006), two approaches can be used in the process of thematic

14

analysis. One way is to examine the answers of pre-set questions, while the other is to allow themes to be formulated from the data. The former was adopted as responses with the data set were examined for content that related to the respondents’ written answers to the five open response questions. Answers were scrutinised closely, coding was undertaken and grouped into conceptual themes. Then themes were grouped together into clusters of themes. Finally, a more thorough analytical and theoretical arranging of themes was carried out. Results Sample Demographic information was collected from the participants and summarised using the larger pre-test cohort. A total of 18 respondents were female (78.3%) and five respondents (21.7%) were male. The majority of participants (14 participants; 60.9%) had been working in healthcare for less than five years. All of the age groups from 18 to 55 were represented. All of the participants except one worked in mental health nursing. All but four had experience of working in inpatient services.

The remaining participant reported a level of ‘satisfied’ to both these questions. All of the participants reported that the use of specific examples taken from the mental health/ learning disabilities field helped then in their understanding of the topic. The PowerPoint presentation and group activities were judged to be the most effective components of the programme; each being cited by nine out of 12 participants. However, videos received the lowest rating – being cited by just five participants for effectiveness, and additionally being cited by five participants as the least effective component of the programme. Content analysis Overall there was a limited response to the open-ended sections inviting a written response. However, these further validated the quantitative analysis, with all comments showing the participants had gained positively from attending the workshop. Four overlapping themes emerged: topic delivery; understanding and learning about the topic; relevance to practice; and future directions.

Pre and post test scores The mean score recorded pre-test was 34.7, with a standard deviation of 0.91. The mean score recorded post-test was 43.2, with a standard deviation of 2.24. Hence the mean score was raised by 8.5 units after the test, with the variability of the data increased. An independent samples t-test was conducted on pre- and post-scores. This approach was necessary in the absence of information relating to pairings of pre- and post-scores, and matching of demographic information to pre- and post-scores. The t-test found a statistically significant difference between pre- and post-scores (t(33)=4.15; p