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Biomedical subjects

C Brooker

Publications and source records attributed to C Brooker.

At least 19 recordsLinked to original sources
PubMed2006

The national continuous quality improvement tool for mental health education: results of targeted and supported implementation in England.

The national continuous quality assurance tool for mental health education and training has recently been developed. This paper describes the planned implementation of the tool across NHS Workforce Development Confederations (WDCs) in England. Large stakeholder groups in 15 WDCS were convened. The groups rated 29 programmes across a range of provisions including pre-qualifying programmes (social work and mental health nursing), post-qualifying programmes, new graduate mental health worker programmes and programmes run within NHS Trusts. Overall, the results indicate that the majority of rated programmes are relevant to the policy agenda and involve service users in a meaningful way. However, courses are less likely to engage with carers and to assess the impact of the programmes. Key factors are identified that promote the implementation of the new quality assurance tool and key barriers to implementation are also elicited. The paper concludes that the tool can provide a useful framework to assess the quality of a broad range of mental health education, furthermore, that it should be incorporated into existing quality assurance systems.

Curriculum↗
PubMed2001

The Fourth Quinquennial National Community Mental Health Nursing Census of England and Wales.

Within an increasingly articulate policy framework, changes to the United Kingdom National Health Service have taken place and these have impacted on mental health service provision. They have particular implications for the work of community mental health nurses (CMHNs). Since 1980, a five-yearly national census of CMHNs has been conducted. Selected findings from the latest census, commissioned by the Department of Health, are set within the context of data derived from the three previous studies. Substantive implications which flow from the changes detected in the practice, organisation and management, and education of community mental health nurses in England and Wales, are discussed.

Adult↗
PubMed2001

Working with a multidisciplinary team in secure psychiatric environments.

1. Research on working with a multidisciplinary team in inpatient mental health care is underdeveloped. 2. Knowledge of how to work as part of a team is taken for granted within the realm of professional training. 3. In effective teams, members value the support, knowledge, and professional development that membership offers. 4. Training teams to be more effective requires diverse educational strategies.

Attitude of Health Personnel↗
PubMed2000

Differences in teaching about the acute sore throat within one medical faculty.

OBJECTIVES: To examine the consistency of teaching about the acute sore throat in four departments in one medical faculty, and to determine whether there is agreement between what is taught and the evidence-based literature. DESIGN: Cross-sectional study. SUBJECTS: 71 undergraduates and 15 postgraduate general practice registrars and four lecturers. RESULTS: Differences were identified in teaching about the diagnostic value of a throat swab, a full blood count and clinical scoring, as well as on the use of penicillin in suspected streptococcal pharyngitis. Only one department based their teaching on the evidence-based literature. No department discussed issues of cost-effectiveness. Half of the students identified discrepancies in the teaching about the sore throat and were initially confused by them. CONCLUSION: One method of resolving disagreement between teachers from different disciplines is to rely on the evidence-based literature. This type of study can be useful in curricular development and in correcting teaching inconsistencies within a faculty.

Acute Disease↗
PubMed1999

The views of nurses to the conduct of a randomised controlled trial of problem drinkers in an accident and emergency department.

The Trent Regional Health Authority funded a study in 1995 to train nurses in an accident and emergency (A&E) department to screen all adult attendees for alcohol problems with a view to identifying a sample of problem drinkers to participate in a randomised controlled trial (RCT). In the RCT identified drinkers were to be assigned either to health education plus brief counselling intervention or, as controls, to health education alone. Despite 16654 attendance's at A&E during the recruitment phase of the study only 20% of attendees were screened of whom a further 19% were identified as problem drinkers by the CAGE screening questionnaire. Less than half of the problem drinkers were, however, provided with feedback by the nurses, leaving a small group of 264 eligible for entry to the RCT. The great majority of this subgroup refused an initial appointment at the specialist clinic and so the trial was abandoned. A number of in-depth interviews were undertaken with the nurses in an attempt to understand ways in which the overall conduct of the study might have been improved. This paper outlines in some detail some of the reasons for the lack of success with the study which include; general environmental factors that undoubtedly led to stress and poor morale amongst the nursing team, the differences in perception between managers and clinical nurses concerning the value of research and the inadequacy of the initial training programme. The paper concludes that there are problems in the NHS which do not provide a helpful backcloth to the successful conduct of health services research.

Adult↗
PubMed1999

Evaluating clinical outcome and staff morale in a rehabilitation team for people with serious mental health problems.

Tameside and Glossop rehabilitation team (in England) have developed a progressive and targeted service for people with serious mental health problems through the systematic implementation of research-based evidence in practice and service configuration. This study was undertaken to provide a method of auditing the clinical outcome of the service and monitoring staff morale in a manner which could be integrated in the day to day delivery of services, and which could inform future service developments. Changes in the functioning of the total population of rehabilitation team clients were assessed over a 1-year period by Health of the Nation Outcome Scales (HoNOS) ratings at 6-monthly intervals. Factors causing stress and stress levels among all staff were assessed using the Mental Health Stress Questionnaire. The findings give clear indications of areas of the service which needed improving or changing, and identify ways in which the ongoing process of data collection might be refined.

Benchmarking↗
PubMed1998

Problems encountered with opportunistic screening for alcohol-related problems in patients attending an accident and emergency department.

AIMS: To assess the value of opportunistic screening in Accident and Emergency (A&E) for patients with alcohol-related problems and provision of an intervention. DESIGN: Screening of A&E attendees for the purpose of recruitment to a randomized trial of a counselling intervention. SETTING: A General Hospital A&E department. PARTICIPANTS: All 17,000 adult A&E attendees, during a 6-month period and all nursing staff working within the department. MEASUREMENTS: Patients' self-reported alcohol consumption, responses to the CAGE questionnaire (four questions designed to identify problem drinking) and proportions offered, and taking up offer of help. FINDINGS: Only 4663 (28%) adult attendees at A&E were actually screened and of these 2% declined and 25% were judged unable to answer. Of the rest, 86% drank alcohol, with 22% drinking in excess of current guidelines or with two or more positive answers to CAGE. Only 41% (264) of those drinking to excess were offered help and 88% of these declined it. This left 13 patients to be included in the trial. CONCLUSION: There is a significant need for an effective intervention in this area but considerable barriers exist to testing the efficacy of potential screening strategies and interventions.

Adult↗
PubMed1998

Difficulties in the measurement of outcome in people who have serious mental health problems.

In the present drive towards evidence-based health care it is essential for nurses to be able to define and measure their contribution in the health services and thereby ensure that resources are deployed to provide maximum improvement in the health of the population. Yet there exist few rigorous studies which examine the impact of the nursing contribution on patient health gain. One explanation for this is the sheer complexity of outcome measurement. This paper considers the multitude of factors which must be taken into account when designing studies to measure the impact of interventions for people with serious mental health problems. The heterogeneous nature of the population, the range of services these people might use, the composite of possible interventions and the paucity of adequate measurement tools are among the issues to be tackled. Although no single methodology can be prescribed, a number of principles are offered to guide study design.

Culture↗
PubMed1998

Outcome after laparoscopic cholecystectomy for chronic acalculous cholecystitis.

Patients with typical symptoms of biliary tract disease but no gallstones on ultrasonography may benefit from cholecystectomy for presumed chronic acalculous cholecystitis. We retrospectively analyzed the outcome of 50 patients with a preoperative diagnosis of chronic acalculous cholecystitis based upon history (chronic or recurrent, postprandial right upper quadrant abdominal pain), the absence of acid-peptic disease, and normal biliary sonography treated with laparoscopic cholecystectomy (LC) and transcholecystic cholangiography from 1991 to 1996. All patients had preoperative cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS). There were 42 women and 8 men with a mean age of 43 years. CCK-HBS was abnormal in 45 patients (< or = 35 per cent gallbladder ejection fraction or nonfilling of the gallbladder). There was no postoperative mortality and one morbidity (urinary retention). All patients had microscopic evidence of chronic cholecystitis. At mean follow-up of 30 months, (range, 7-62 months) 39 patients (78%) were free of abdominal pain. Thirty-five of 45 patients with abnormal CCK-HBS were pain free (positive predictive value, 0.78). Four of five patients with normal CCK-HBS were pain free (negative predictive value, 0.20). The positive and negative likelihood ratios for CCK-HBS were 0.99 and 1.13, respectively, confirming that this test was not useful for predicting benefit from LC. Seven patients with persistent right upper quadrant pain had abnormal postoperative sphincter of Oddi manometry; they improved after endoscopic sphincterotomy. Patients with symptoms typical of biliary colic with normal gallbladder sonography and absence of acid-peptic disease benefit from LC in the majority of cases. Those who remain symptomatic after LC may benefit from endoscopic retrograde cholangiopancreatography with sphincter of Oddi manometry and endoscopic sphincterotomy when manometry is abnormal.

Adult↗
PubMed1997

Mapping the difficulties experienced by clinicians and managers in health and social care who are seeking to develop research skills.

In 1994 the Department of Health commissioned project work and reviews to inform the development of a National Strategy to enhance the capacity of the NHS workforce to contribute to Research and Development. This paper reports one aspect of this review: a preliminary study mapping the difficulties experienced by clinicians and managers who sought to develop their research skills. A range of professionals were included in the sample, all of whom had applied for funding to undertake research education or training through a variety of schemes offering differing levels of support. There was a remarkable degree of consistency between the professional groups in terms of their level of training, success in achieving funding and their perception of the difficulties they faced in pursuing funding for research training--which they ranked in the same order of importance. However, two major significant differences arose: nurses and therapists rated their managers as less helpful, and they felt that completing application forms for research training was a skill that they lacked. The ranking of areas of difficulty, and the additional comments made by all respondents highlight issues that need to be addressed within a coherent strategic framework to reduce the difficulties experienced by those professionals wishing to pursue funding for research training.

Adaptation, Psychological↗
PubMed1994

The outcome of training community psychiatric nurses to deliver psychosocial intervention.

BACKGROUND: A prospective quasi-experimental design was used to evaluate the effect of training CPNs to undertake psychosocial intervention with families caring for a relative with schizophrenia. METHOD: Patients meeting predetermined criteria were allocated to either an initial waiting-list control group or a delayed intervention group. The CPNs were trained to offer family interventions to a total target group of 48. Treatment was eventually accepted by 85%, of whom 81% (n = 34) were followed-up for 12 months. Families received a weekly mean session of 47 minutes (compared with 33 minutes in the controls). The main outcome measures are frequency and severity of symptoms (KGV), social functioning (SFS) and days in hospital. Carers' minor psychiatric morbidity (GHQ) and knowledge (KASI) are also reported. RESULTS: In the patient group both the positive and negative symptoms of schizophrenia improved significantly (P < or = 0.001 and P < or = 0.01 respectively) to 12-month follow-up, as did a global measure of social functioning (P < or = 0.001). Tentative evidence was also collected that family intervention reduced in-patient episodes. Benefits for relatives included a decrease in minor psychiatric morbidity (P < or = 0.05) and an increase in knowledge about neuroleptic drugs (P < or = 0.001). CONCLUSIONS: The study offers some evidence that CPNs can be taught to improve the outcome for families who care for a relative with schizophrenia.

Activities of Daily Living↗
PubMed1993

Training in psychosocial intervention: the impact on the role of community psychiatric nurses.

A group of community psychiatric nurses (CPNs) received training via a short part-time course to deliver psychosocial intervention (PI) to families caring for a relative with schizophrenia living at home. The effects on CPNs of training in PI were examined by measuring, over time, a number of variables which reflected; CPNs' attitudes to schizophrenia, their skills, specific aspects of their role (such as visit length and frequency, caseload composition, etc.), and relationships with other disciplines. Analysis of the information showed that CPNs trained in PI changed their attitude to schizophrenia very little. However, evidence was obtained that CPNs' attitudes moved towards behaviour therapy as a preferred treatment approach. All CPNs who received training were competent in the component and global skills of PI at the end of training. These scores derived from blindly rated audiotaped recordings of CPN intervention. The CPNs estimated that caseload size and the proportion of people on caseloads with a diagnosis of schizophrenia did not alter. However, significant increases in the length of CPN sessions with people with schizophrenia and their families were observed. The CPN's liaison role with consumer groups, such as the National Schizophrenia Fellowship, significantly improved. Multi-disciplinary colleagues gave PI-trained CPNs a mixed reaction. Some CPN colleagues seemed pleased to transfer families to the PI-trained CPNs' caseloads, whilst others clearly regarded the PI-trained CPNs as a threat. Overall, the most encouraging reaction came from psychologists and psychiatrists.

Adult↗
PubMed1992

Training community psychiatric nurses for psychosocial intervention. Report of a pilot study.

Community psychiatric nurses were trained to deliver psychosocial intervention to clients with a diagnosis of schizophrenia living at home with relatives. The training package consisted of family assessment, health education, and family stress management strategies. In a 'quasi-experimental' design, a sample of families (n = 54) were recruited to either a control or experimental condition and followed up for 12 months. A number of favourable outcomes were observed in the experimental group, including improvements in the client's target symptoms, personal functioning, and social adjustment. Relatives' satisfaction with services increased and reports of their own minor psychiatric morbidity improved.

Adolescent↗
PubMed1991

Working with families caring for a relative with schizophrenia: the evolving role of the community psychiatric nurse.

This paper describes the effect on the role and function of the community psychiatric nurse (CPN) after training to deliver psychosocial intervention to families caring for a relative with schizophrenia living at home. The study was undertaken as part of a larger investigation, commissioned by the Department of Health, which is examining outcome in families after CPNs have received training in psychosocial intervention strategies. In the last decade four major controlled studies have shown that relapse in schizophrenia can be improved if families receive; detailed assessments of individual need, health education about schizophrenia, and family stress management programmes, often defined as "psychosocial intervention". Whilst these research programmes have been underway, CPN services have been developing closer links with Primary Health Care and individual CPN's work with clients with severe and long-term mental illness has, as a consequence, been reducing. This trend has been rightly criticized, as has the tendency for CPN work to focus on the individual rather than the family with whom the client often lives. Informal carers willingly accept the burden of care for their relatives but their own needs are all too often neglected. The pilot phase of the outcome study demonstrated that after CPNs had received experimental training in psychosocial intervention, families reported a number of positive benefits when followed up for 12 months. First, for the clients there were improvements in the symptoms of their illness and in their social functioning. Second, carers' satisfaction with the service received showed a marked improvement as did their estimates of minor psychiatric morbidity. These changes in outcome entailed a cost. Experimental CPNs reported that undertaking family intervention was more time-consuming than "traditional" CPN care of the client with schizophrenia. Further, the data reveal that the training led to CPNs extending their role in a variety of other ways even though they received only a modicum of support from colleagues within their own health authorities. This preliminary paper concludes that although family work undertaken by CPNs should be seen as an important priority, problems may arise as services attempt to juggle finite resources with ever growing demands. Guidance on the future role of the CPN from the Department of Health is essential and would greatly enable planners and managers alike to rank order service priorities.

Community Health Nursing↗
PubMed1990

Expressed emotion and psychosocial intervention: a review.

For thirty years research has been consistently demonstrating the validity of the concept of 'High Expressed Emotion' (HEE). After early pioneering work by Brown it was established that environmental influences, particularly, the emotion expressed by relatives to sufferers of schizophrenia, are strongly implicated in relapse. Consequently, the predictive validity of HEE has been revealed in a number of cross-cultural studies around the world. In addition, there is strong evidence from well designed intervention studies, that relapse, in schizophrenic clients living at home, can be prevented by the manipulation of social and environmental factors. The combined body of research that has now accumulated allows an hypothesis to be made about the aetiology of the illness, schizophrenia, itself. This theory has been described as the 'stress vulnerability' model. The paper concludes that psychosocial intervention strategies are effective but that, unfortunately, to date, their application has been mostly restricted to the intervention studies themselves.

Cross-Cultural Comparison↗
PubMed1990

The application of the concept of expressed emotion to the role of the community psychiatric nurse: a research study.

The previous article examined the development of the concept of 'expressed emotion', argued that controlled studies had successfully demonstrated the value of psychosocial intervention, but demonstrated that such a therapeutic approach had been mostly limited to the research studies themselves. In the light of the demonstrable efficacy of psychosocial intervention, the psychiatric nursing literature is reviewed in order to establish how far nurses have capitalized on the utility of the 'expressed emotion' concept, to date, in their work with schizophrenic clients and their families. In addition, a brief historical overview of the Community Psychiatric Nurses' (CPNs) role with schizophrenic clients is presented which relates to current ongoing research in this area which is described. In brief, the research project, which is funded by the Department of Health, is evaluating the outcome of teaching CPNs to deliver psychosocial interventions to families caring for a schizophrenic relative at home.

Community Mental Health Services↗