Where does responsibility end?
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Homicide↗
Biomedical subjects
Kevin Gournay
Publications and source records attributed to Kevin Gournay.
The development and internal consistency of the satisfaction with Antipsychotic Medication Scale.
BACKGROUND: Satisfaction with antipsychotic medication is an important outcome variable. To date, there is a lack of a well-established measure to quantify patient satisfaction with psychiatric medication. This paper describes the development, dimensionality, reliability and validity of the Satisfaction with Antipsychotic Medication (SWAM) scale. METHOD: Clinical and academic experts devised a 33-item Likert scale satisfaction questionnaire. Following a pilot study in a sample of 69 people with schizophrenia, 315 people with schizophrenia on the caseload of local mental health services in three London boroughs completed the questionnaire. The dimensionality, internal consistency and validity of the devised instrument were assessed. RESULTS: Reliability of the SWAM scale was good for subscales and total scores. The alpha coefficient for the two subscales: treatment acceptability and medication insight were 0.92 and 0.84 respectively. The a coefficient for the SWAM scale total score was 0.91 and ranged from 0.92 to 0.90. CONCLUSION: Testing of the psychometric properties of the SWAM scale demonstrate that it is a reliable instrument for measuring patient satisfaction with antipsychotic medication. The measure could be used in routine clinical practice in mental health services to assess patient satisfaction with psychiatric medication.
Adult↗
Effect of a medication management training package for nurses on clinical outcomes for patients with schizophrenia: cluster randomised controlled trial.
BACKGROUND: Non-compliance attenuates the efficacy of treatments for physical and mental disorders. AIMS: To assess the effectiveness of a medication management training package for community mental health nurses (CMHNs) in improving compliance and clinical outcomes in patients with schizophrenia. METHOD: Pragmatic randomised controlled trial. Sixty CMHNs in geographical clusters were assigned randomly to medication management training or treatment as usual. Each CMHN identified two patients on their case-load who were assessed at baseline and again after 6 months by a research worker. The primary efficacy outcome of interest was psychopathology, measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS: Nurses who had received medication management training produced a significantly greater reduction in patients'overall psychopathology compared with treatment as usual at the end of the 6-month study period (change in PANSS total scores: medication management -16.62, treatment as usual 1.17; difference -17.79; 95% CI -24.12 to -11.45; P<0.001). CONCLUSIONS: Medication management training for CMHNs is effective in improving clinical outcomes in patients with schizophrenia.
Adult↗
The effect of medication management training on community mental health nurse's clinical skills.
Background. There is evidence that compliance therapy improves treatment adherence and clinical outcomes in patients with schizophrenia. Community Mental Health Nurses (CMHNs) are ideally placed to deliver compliance therapy but require training to develop the necessary clinical skills.Aim. To explore whether a brief medication management training package is effective in developing the compliance therapy skills of CMHNs.Method. The study had a within subjects repeated measures design. A representative sample of 52 CMHNs entered the study. They performed a role-play task pre- and post-training that was videotaped and blind rated by an independent rater using the Cognitive Therapy Scale (CTS). Knowledge was assessed pre- and post-training using a knowledge about medication management questionnaire. Trainees also completed a satisfaction with training questionnaire at the end of the course.Results. Following training there was a statistically significant improvement in mean scores on the primary measure of skills, the CTS (mean pre-training CTS-total score 13.88, mean post-training CTS-total score 31.12; p<0.01). There was also a significant categorical improvement in the number of trainees who demonstrated satisfactory skills. Knowledge about medication management was significantly improved and trainees reported that training was acceptable and relevant to their clinical practice.Conclusions. In this uncontrolled study training improved the medication management skills of CMHNs.
Clinical Competence↗
The content of management of violence policy documents in United Kingdom acute inpatient mental health services.
AIM OF THE STUDY: The aim of the study was to examine the content of Trust policies concerning the prevention and management of violence in acute in-patient settings in order to establish their usefulness as guidance for staff in this difficult, complex, and controversial aspect of inpatient psychiatric care. BACKGROUND: Violence is a commonly encountered problem in inpatient psychiatric settings. There are legal requirements for workplaces in general and mental health care facilities in particular to develop safe systems of work based upon the findings of assessments of this risk. Policies have a key role to play in making explicit the responsibilities of both employer and employees, and specifying standards of acceptable practice. DESIGN: A cross-sectional survey methodology was used, which entailed examination of the content of management of violence policies that had been forwarded to the authors from 40 Trusts providing acute inpatient psychiatric care throughout England, Scotland, Wales, and Northern Ireland. FINDINGS: Policies were found to vary widely in their content, and serious shortcomings were noted in the extent to which policies included information regarding their status and review, advice on the prevention of violence, the management of violent incidents, and postincident action. CONCLUSIONS: Further research is needed to tease out the extent to policies which are lacking in content, reflect shortcomings in the organizational approach to the prevention and management of violence by Trusts, and the extent to which such shortcomings result in harm being suffered by staff and/or patients. An alternative format for the presentation of management of violence policies is discussed, and items that should be included in inpatient units' management of violence policies are suggested.
Cross-Sectional Studies↗
Knowledge, confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training.
BACKGROUND: NHS Direct, the United Kingdom's 24-hour nurse-led telephone advice service, was announced in December 1997. By November 2000 the service was available throughout England and Wales. Initial research had shown that people with mental health problems used the service and that, prior to its going live, this was one area about which nurses felt least confident. AIMS: The aim of the study was to measure confidence in dealing with mental health calls, knowledge of mental health issues, and attitudes to mental health before and after training. METHODS: A postal questionnaire was sent to all nurse advisers working in 17 NHS Direct sites in England before and after mental health training had been received. The questionnaire was designed to measure confidence, knowledge and attitudes. This was done through scenarios of real calls to NHS Direct, questions from the World Health Organization guide to Mental Health in Primary Care and the Depression Attitude Questionnaire. RESULTS: Confidence increased in nurses who received mental health training. Although there was no statistically significant increase in knowledge scores after training, those who had received training increased by on average one point. After training, attitudes towards depression had shifted in that nurses now felt more positive towards their role in treating depressed patients. CONCLUSIONS: Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.
Adult↗
A UK perspective of case management.
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Case Management↗
Prescribing: the great debate.
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Drug Prescriptions↗
Assessment and management of obsessive compulsive disorder.
This article outlines the nature of obsessive compulsive disorder and sets out an evidence-based approach to assessment and treatment. The article also examines the key elements of the National Institute for Health and Clinical Excellence (2005) guideline on this condition.
Causality↗