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Clark LL, Zagni M, While AE. 'No health without mental health': where are we now? Br J Community Nurs 2024; 29:282-287. [PMID: 38814835 DOI: 10.12968/bjcn.2024.29.6.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.
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Affiliation(s)
| | | | - Alison E While
- Emeritus Professor of Community Nursing, Faculty of Nursing, Midwifery and Palliative Care, King's College London; Fellow of the Queen's Nursing Institute
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2
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While AE, Clark LL. Management of work stress and burnout among community nurses arising from the COVID-19 pandemic. Br J Community Nurs 2021; 26:384-389. [PMID: 34343046 DOI: 10.12968/bjcn.2021.26.8.384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.
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Affiliation(s)
- Alison E While
- Emeritus Professor of Community Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London; Fellow of the Queen's Nursing Institute
| | - Louise L Clark
- Visiting Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Dickinson T, Clark LL. Rapid tranquillisation: an issue for all nurses in acute care settings. ACTA ACUST UNITED AC 2021; 29:880-883. [PMID: 32790562 DOI: 10.12968/bjon.2020.29.15.880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The management of challenging behaviour, violence and aggression is not only an issue for mental health and learning disability nurses. Increasingly, nurses working in emergency departments (EDs), medical assessment units and general medical or surgical wards may encounter acts of challenging behaviour, violence and aggression on a regular basis. Restraint is sometimes used as a tool in the management of these patients; this may be in the form of physical, mechanical or chemical restraint. Rapid tranquillisation (RT) is often considered a form of chemical restraint, which may be used in an emergency situation when prescribed. If RT is given it should be done so as the least restrictive option, with intramuscular and intravenous administration as a last resort. Patient monitoring following administration is paramount. This article explores best practice in the administration of RT from a clinical perspective.
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Affiliation(s)
- Tommy Dickinson
- Head of the Department of Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Louise L Clark
- Senior Teaching Fellow in Mental Health and Intellectual Disability Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Bynoe S, Collin J, Clark LL. Reducing restrictive practice: a pertinent issue for children's services. ACTA ACUST UNITED AC 2021; 30:70-73. [PMID: 33433280 DOI: 10.12968/bjon.2021.30.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of 'restrictive practices' across all sectors of health care, including the difference between 'restrictive practices' (such as attitudes of control, limit setting and unnecessary ward rules) and 'restrictive interventions' (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.
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Affiliation(s)
- Sheena Bynoe
- Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Jacqueline Collin
- was Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, at the time of writing
| | - Louise L Clark
- Senior Teaching Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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McDonald G, Clark LL. Mental health impact of admission to the intensive care unit for COVID-19. Br J Community Nurs 2020; 25:526-530. [PMID: 33161746 DOI: 10.12968/bjcn.2020.25.11.526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.
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Affiliation(s)
- Grace McDonald
- Teaching Fellow, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Louise L Clark
- Programme Leader-MSc Mental Health Nursing, Department of Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Baker E, Clark LL. Biopsychopharmacosocial approach to assess impact of social distancing and isolation on mental health in older adults. Br J Community Nurs 2020; 25:231-238. [PMID: 32378460 DOI: 10.12968/bjcn.2020.25.5.231] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
It is impossible to predict or comprehend the impact of the ongoing COVID-19 pandemic. The UK Government's advice for vulnerable people, including older adults, to move towards self-isolation and social distancing is likely to reduce rates of transmission, the risk of severe illness and the impact on the acute health services. Although justified and necessary, this process of isolation is likely to have a negative impact on the mental health of these vulnerable groups, especially older people. It will become increasingly important for community health professionals to assess subtle changes in older persons' mental health, as the duration of this period of isolation remains unclear. The biopsychopharmacosocial model provides one method of assessing mental health and planning health and social care needs. This article hopes to guide community health professionals through the specifics of this assessment model in relation to the growing COVID-19 pandemic.
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Affiliation(s)
- Edward Baker
- Clinical Doctoral Research Fellow, King's College London, King's College Hospital NHS Foundation Trust
| | - Louise L Clark
- Senior Teaching Fellow in Mental Health and Learning Disability Nursing, King's College London
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Üzar-Özçetin YS, Trenoweth S, Clark LL, Hext G, Tee S. Could therapeutic diaries support recovery in psychiatric intensive care? ACTA ACUST UNITED AC 2020. [DOI: 10.12968/bjmh.2019.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite growing literature surrounding the use of patient diaries in intensive care units within general health care and the positive effects these may have on a patient's psychological recovery from such an admission, no studies exist examining the effects of similar patient diaries in psychiatric intensive care units when used with people experiencing an acute exacerbation of psychosis. This article hypothesises the potential positive effects of diaries kept for patients in psychiatric intensive care units. In the development of strategies to help people in psychiatric crisis understand and manage their own distress and psychological trauma, diaries may be helpful for the prevention of further psychological problems and aid recovery post discharge. Research is required to consider the possible effects of therapeutic diaries and the role of the multidisciplinary team in keeping these within psychiatric intensive care settings.
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Affiliation(s)
| | - Steve Trenoweth
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Louise L Clark
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - Greg Hext
- HCA Group, London Bridge Hospital, London, UK
| | - Stephen Tee
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Clark LL, Lekkai F, Murphy A, Perrino L, Bapir-Tardy S, Barley EA. The use of positive behaviour support plans in mental health inpatient care: A mixed methods study. J Psychiatr Ment Health Nurs 2020; 27:140-150. [PMID: 31538692 DOI: 10.1111/jpm.12566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint. Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan. However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended. Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients. Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients. Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. Abstract Introduction An international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited. Aims To evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care. Methods Mixed methods-quality ratings and interviews with relatives and nurses. Results Positive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour. Discussion The potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed. Implications for practice Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach.
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Affiliation(s)
- Louise L Clark
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Fiorinta Lekkai
- College of Nursing, Midwifery and Healthcare, University of West London, Brentford, UK
| | | | - Luisa Perrino
- School of Human and Social Sciences, University of West London, Brentford, UK
| | - Savin Bapir-Tardy
- School of Human and Social Sciences, University of West London, Brentford, UK
| | - Elizabeth Alexandra Barley
- College of Nursing, Midwifery and Healthcare, University of West London, Brentford, UK.,School of Health Sciences, University of Surrey, Guildford, UK
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Hext G, Clark LL, Xyrichis A. Reducing restrictive practice in adult services: not only an issue for mental health professionals. ACTA ACUST UNITED AC 2019; 27:479-485. [PMID: 29749785 DOI: 10.12968/bjon.2018.27.9.479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Reducing 'restrictive practices' is an issue of national importance, pertinent to all NHS sectors, yet there is poor awareness of the issue in mainstream adult services. Such practices potentially restrict a person's rights to choice, self-determination, privacy and freedom. Challenging behaviour is often the result of unmet needs, communication difficulties or diagnostic overshadowing, but there is a common misconception that patients exhibit such behaviours because of their impaired intellectual abilities or mental health problems. This article seeks to raise awareness of restrictive practices and suggest the way forward. It highlights the importance of good de-escalation skills, which, if adopted early in therapeutic relationships, may help reduce the occurrence of challenging behaviours and situations. Behavioural support plans that adopt a biopsychopharmacosocial approach (BPPS) detail a range of interventions for managing challenging behaviours. Tailored support that follows a BPPS approach could reduce incidents of challenging behaviour, reduce costly observation, improve the patient experience and protect the patient's liberty.
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Affiliation(s)
- Greg Hext
- Lead Nurse, Marjory Warren Acute Medical Unit, Charing Cross Hospital, Imperial College NHS Healthcare Trust
| | - Louise L Clark
- Senior Teaching Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Andreas Xyrichis
- Lecturer, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Xyrichis A, Hext G, Clark LL. Beyond restraint: Raising awareness of restrictive practices in acute care settings. Int J Nurs Stud 2018; 86:A1-A2. [DOI: 10.1016/j.ijnurstu.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Clark LL, Merrick I, O'Driscoll F, Lycett H, White R, White A. Template for action for patients with intellectual disabilities in mental health services. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjmh.2017.6.6.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Louise L Clark
- Senior Teaching Fellow, Florence Nightingale Faculty of Nursing and Midwifery, Kings College London
| | - Ian Merrick
- Professional lead occupational therapist, community services, West London Mental Health Trust, London
| | - Fiona O'Driscoll
- Lead occupational therapist, Ealing Recovery Services, West London Mental Health Trust, London
| | - Helen Lycett
- Strategic trust lead for occupational therapy and allied health professions, West London Mental Health Trust, London
| | - Robert White
- Primary care mental health service team manager, West London Mental Health NHS Trust, London
| | - Anna White
- Service user carer; honorary psychotherapist, West London Mental Health Trust, London
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Cort E, Meehan J, Reeves S, Howard R. Very Late-Onset Schizophrenia-Like Psychosis: A Clinical Update. J Psychosoc Nurs Ment Health Serv 2017; 56:37-47. [PMID: 28990640 DOI: 10.3928/02793695-20170929-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/07/2017] [Indexed: 11/20/2022]
Abstract
Psychosis symptoms (delusions and hallucinations) are multifactorial in origin and, in later life, occur in the context of schizophrenia, delirium, dementia, delusional and schizophrenia-like disorders, mood disorders, and alcohol or substance abuse. The current article provides a clinical overview of very late-onset (after age 60) schizophrenia-like psychosis (VLOSLP), summarizing the literature on treatment options and reflecting on the role of psychiatric-mental health nurses (PMHNs). Increased awareness of the clinical presentation, key features, and evidence-based treatment options will assist PMHNs to confidently recognize this often under-diagnosed disorder and adopt a more assertive role in terms of engagement and follow up. Pragmatic research involving individuals with VLOSLP is required to increase the evidence base for treatment and improve outcomes of care. [Journal of Psychosocial Nursing and Mental Health Services, 56(1), 37-47.].
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Clark LL, Shurmer DL, Kowara D, Nnatu I. Reducing restrictive practice: Developing and implementing behavioural support plans. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjmh.2017.6.1.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Louise L Clark
- Nurse consultant in acute and restrictive practice: West London Mental Health Trust; and visiting lecturer, King's College London
| | - Darren L Shurmer
- Healthcare assistant, West London Mental Health Trust, Askew Ward; seconded postgraduate mental health nursing student, Florence Nightingale Faculty of Nursing and Midwifery, King's College London
| | - Dominika Kowara
- Registered mental health nurse, West London Mental Health Trust, Askew Ward
| | - Ian Nnatu
- Consultant psychiatrist, West London Mental Health Trust, Askew Ward; and honorary senior clinical Lecturer, Imperial College, London
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