Assessing Nurse-Initiated Care in a Mental Health Crisis Assessment and Treatment Team in Australia

Happell, Brenda; Sundram, Suresh; Wortans, Julie; Johnstone, Harry; Ryan, Rob; Lakshmana, Raju

doi:10.1176/appi.ps.60.11.1527

Cited by 2 publications

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“…No statistical tests or numerical results reported Doyle (1994) [ 32 ] 3 Natural experiment with parallel groups: 1 Team in Folkestone, UK 1 Team in Barnet, UK Folkestone CRT with 9 am-5 pm opening hours No clear difference between CRT models reported and no statistical tests reported. Over the follow-up period Barnet CRT with 24 hour opening 9% of the 9-5 (Folkestone) CRT service users were admitted to hospital vs 5% Barnet Happell (2009) [ 33 ] 3 Natural experiment with pre- and post-comparison of parallel groups; Melbourne, Australia Control Group: Day after initial assessment, full assessment given by trainee psychiatrist , care management plan formulated. Mean HoNOS scores not significantly different between the groups at baseline – no p-values reported Treatment Group: Day after initial assessment, full assessment given by nurse practitioner , who took role of trainee psychiatrist (After 7 days service users in nurse-initiated care group reverted to treatment as usual) HoNoS scores for both groups significantly improved with treatment (difference for control group: t = 7.90, df = 51, p < .001; difference for treatment group: t = 6.90, df = 50, p < .001) No information given as to whether there was a significant difference between group HoNOS scores after treatment.…”

Section: Resultsmentioning

confidence: 99%

“…However the impact of this change in referral criteria on client or service outcomes was not evaluated. Three studies found no clear or significant difference between outcomes of the different CRT models regarding: organisational changes within the same team [ 31 ]; team opening times (9 am-5 pm versus 24-hours) [ 32 ]; and assessments by trainee psychiatrist versus by nurse practitioner [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

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Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Wheeler¹,

Lloyd‐Evans²,

Churchard³

et al. 2015

BMC Psychiatry

135

132

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BackgroundCrisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users’ satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs.MethodsA systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders’ views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies.ResultsSixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs’ ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training.ConclusionsWe cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders’ views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable.Trial registrationProspero CRD42013006415.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0441-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Wheeler¹,

Lloyd‐Evans²,

Churchard³

et al. 2015

BMC Psychiatry

135

132

View full text Add to dashboard Cite

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La pratique infirmière avancée : un choix qui s’impose pour la qualité des soins et services en santé mentale

Ricard

Page

2014

smq

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La refonte des lois professionnelles et la réorganisation des services en santé mentale ont eu une influence significative sur la pratique infirmière en santé mentale au Québec. De nombreuses infirmières ont fait preuve de leadership clinique et ont su adapter leurs services aux besoins de la population selon les nouveaux milieux de soins de proximité. Cependant, plusieurs sont d’avis que le rôle des infirmières n’est pas suffisamment connu et mis à profit pour contribuer de façon optimale à l’offre de services en santé mentale. Ainsi, cet article porte un regard critique sur la pratique infirmière en santé mentale au Québec et les conditions essentielles à son évolution. Il vise à : 1) décrire les tendances actuelles qui caractérisent l’évolution des rôles et la modernisation de la pratique infirmière en santé mentale au Québec ; 2) offrir un aperçu de l’évolution de la pratique infirmière avancée en santé mentale (PIA-SM) et de ses retombées sur la qualité des services ; 3) clarifier le concept de PIA et situer son évolution au Québec ; et 4) proposer diverses stratégies visant à optimiser le rôle des infirmières et leur complémentarité avec les autres professionnels dans l’offre de services en santé mentale. Les progrès en cours sont illustrés par des exemples de pratiques innovantes développées par des infirmières québécoises dans le contexte de la restructuration des services de santé. Les données quant à l’évolution de la PIA-SM aux États-Unis et en Australie indiquent qu’il existe encore de nombreux défis liés à l’implantation réussie de ce nouveau rôle. Toutefois, il se dégage, de la majorité des études, un consensus de plus en plus important quant à la contribution de la PIA-SM pour améliorer la qualité et l’accessibilité des soins en santé mentale. La réforme des services de santé mentale au Québec s’avère donc être un moment propice pour développer et soutenir la PIA-SM et en retirer les bénéfices attendus.

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Assessing Nurse-Initiated Care in a Mental Health Crisis Assessment and Treatment Team in Australia

Abstract: The findings indicate that the nurse practitioner role can potentially initiate safe and effective mental health care and treatment that is as satisfying as that initiated by a physician. Additional, larger-scale research is required to determine the generalizability of these findings.

Cited by 2 publications

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Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review

La pratique infirmière avancée : un choix qui s’impose pour la qualité des soins et services en santé mentale

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