Biomedical subjects
Publications and source records attributed to I Ryrie.
The NHS plan proposed the establishment of 220 specialist assertive outreach teams for people with serious mental illness by 2003. Research on the development of these teams in London shows that diverse models are in operation. Some focus on medication administration, others on psychosocial needs. It is important that these teams are incorporated into the spectrum of care services.
Since the early 1980s, government policy documents and specialist reports have encouraged the involvement of general practitioners (GPs) in the treatment of problem drug users. In spite of such policy initiatives, their involvement has been patchy and slow. In response to this apparent reluctance, the London Boroughs of Brent and Harrow established the substance misuse management project (SMP) to support and train GPs in the management of substance misuse. The SMP is a GP-led project that provides ongoing support, shared-care protocol, primary care team training, treatment audits and financial reimbursements. In 1996, the SMP worked with GPs who were not currently involved in treating problem drug users, and those who were providing only minimal interventions. This paper evaluates the training and support given to these GPs and examines changes in their practice. A pre- and post-test survey was undertaken of GP knowledge, attitudes and levels of activity. A structured questionnaire was administered to all GPs before training (n=40) and re-administered between 6 and 9 months following training. SMP audit data were also reviewed to validate any reported changes in practice. All GPs initially reported insufficient knowledge to manage problem drug users. One-fifth were unaware they could prescribe methadone, and nearly half believed drug problems should be treated by specialist services. Post-training, the GPs had increased their levels of treatment activity and reported greater confidence and willingness to treat. This study demonstrates the potential to involve GPs in the treatment of problem drug users. The training was part of a package that included ongoing support sessions, team training, audits of treatment and financial reimbursements. It is proposed that, whilst training is a necessary condition, a more comprehensive package of support is needed to facilitate the treatment of problem drug users in primary care.
Debates over title, grades and relationships across the profession has tended to dominate the literature in advancing nursing practice. Fewer research projects have attempted to study the activities of nurses who are designated as undertaking advancing nursing roles. One study evaluating Masters courses for Clinical Nursing Practice and a second addressing the impact of the 'Scope of Professional Practice' (United Kingdom Central Council for Nursing, Midwifery & Health Visiting, 1992) document by this team of authors afforded these research opportunities. In this paper empirical data from 'reflective' observation with 19 nurses (including midwives and health visitors) are presented to illustrate the range and type of functions undertaken by a small group of practitioners developing their practice. A number of characteristic features emerged. Assessment of individual and group needs, positive motivation to constantly improve practice, inter-disciplinary and cross agency working for planned change and an ability to identify and prioritize service requirements were recognised in these nurses' roles. Certain personal attributes were seen to be essential for successful role development such as confidence, commitment and problem solving powers combined with a positive working environment and supportive managers.
In response to the British government's Review of Mental Health Nursing this paper reports on a study which examined nursing practice in two inner city acute admission wards. Eight nursing staff maintained a record of their activities over a 7-day period according to four operationalized variables. Qualitative detail was also collected to enable the specification of activities. The amount of time available for patient contact work is calculated and those activities which currently restrict opportunities for experienced nursing staff to have therapeutic interactions with their patients are identified. The findings do not differ markedly from earlier studies and some tentative conclusions are drawn concerning the therapeutic milieu within an inner city psychiatric in-patient facility.
This paper reports on a small-scale study undertaken in two inner city acute psychiatric wards to identify the proportion of patients known to use drugs or alcohol and the perceptions of staff regarding these patients. Data collection involved a retrospective audit of patient notes and the administration of a questionnaire to nursing staff. The findings were broadly consistent with other research studies. Over half of the patient sample was reported to use illicit drugs or alcohol and in one third of cases this use was thought to have contributed to their current admission. Questionnaire results indicated that staff felt ill-equipped to offer an adequate response although all respondents welcomed opportunities to develop their knowledge and skills. The findings are discussed in light of the existing literature, and some tentative conclusions are drawn concerning the development and provision of effective integrated services for individuals with psychiatric and psychoactive substance use disorders.
The Mental Health Nursing Review Team recommend research to examine the potential of liaison mental health nursing. This paper describes a study into the work of two emergency psychiatric nurses (EPN) attached to a central London accident and emergency (A&E) department. A semi-structured interview schedule was employed to generate data on role development and purpose, and a retrospective survey of clinical activity was carried out over a 94-day period. Specific attributes and working practices, which promoted integration within the A&E department, are identified as are the reasons for referring patients to the EPNs, patients' primary problems on assessment, assessment outcome and the staff involved in each assessment. Findings are considered in relation to the various models of psychiatric consultation and liaison found in the literature. The scope and quality of the available data is also assessed and recommendations are made to enable a more robust prospective study to be undertaken.
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A ward manager has set up a forum where carers of relatives or friends with mental health problems can discuss and find solutions to their problems. In 1994, relatives and carers were invited to join the special hospital-based group, which met every fortnight. The ward manager was present in a facilitative role, but a 'bottom-up' approach focused on the needs and wishes of participants. In this paper, the author stresses the importance of respecting participants' views, and communicating complaints to the relevant hospital departments.
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