Category: Uncategorized

Person-centred E Mental Health

Explore, Build and Connect workshop

Philosophy and knowledge development pedagogy

The philosophy for this workshop is a participant -centred learning design and this aligns with person-centred approaches to mental health care, aligning practice, innovation and research with participant learning experiences in a unique and relevant way.

The pedagogy for learning and knowledge development in this workshop is underpinned by an Explore, Build and Connect framework that is suitable for face-to-face and online learning formats (Alkhaldi et al., 2016; Gallo, 2011; Howatson-Jones, Thurgate, Harnett, Thompson, & Jordan, 2013; Lau, 2011; Paliadelis et al., 2014; Wilson & Hungerford, 2015). The framework will help in building consistent and equitable learning experiences across groups, and will assist workshop leaders to provide participants with a satisfying learning experience.

This framework accommodates a storytelling and case based approach to learning about the topic areas and facilitates opportunities for participants to reflect on their knowledge development as they imagine clinical, innovation and research applicability (Paliadelis et al., 2014). The use of an explore, build and connect framework integrates learning across all three learning domains and this approach builds a common learning scaffold between learning/ knowledge development interactions during face-to-face sessions, and as work integrated learning to transform practice. Thus, knowledge is formed and shared using social interactions in to build a collective intelligence among participants (Lau, 2011). Internet-based learning resources including social media, and forum discussion extend the knowledge exchange methods that promote the development of moral reasoning for health professionals and provide a practical skill set for participants who will increasingly be required to blend not only their learning across digital and real life domains, but also their clinical practice in digital and face-to-face domains (Arrigoni, Alvaro, Vellone, & Vanzetta, 2016; Rolls, Hansen, Jackson, & Elliott, 2016; Wilson, Ranse, Cashin, & McNamara, 2013).

But first…  Mindful preparations… with a cup of coffee!

Aim
To explore new ideas, build new knowledge based on evidence and connect new knowledge to transformative practice. The idea is – you will need some peers and colleagues to share your ideas with… and to listen to others ideas… to co-produce a shared knowledge.

Objectives

At the end of this session you will:

  • Have had the opportunity to explore and discuss new concepts related to the topic with peers in a safe environment where ideas are valued, and vulnerability with new material is respected.
  • Have participated in building a new shared and co-produced knowledge with a small group of peers.
  • Have been exposed to compelling evidence (or significant knowledge gap) to support new ideas, and/or new questions to develop & transform evidence base or practice.
  • Have an opportunity to interrogate some evidence and propose how it aligns, or misaligns with practice, innovation or research frameworks and agendas.
  • Connect the new knowledge that has been co-created, to practical and transformative settings.
  • Take-away (or transact) a new applied knowledge that has been developed using group-based co-creative and transformative processes, for application within a community of practice.

Some definitions…

What do we mean by Person-centred Mental Health….?

A person-centred approach is concerned with human connectedness: the capacity for feelings to be received and understood, and lives to be revealed… illuminates the needs of the person with a mental health condition, her or his family, carers and clinicians through an interactive process of dialogue & information exchange (Procter et al, 2014)

What are…

Digital interventions are defined as programs or resources that provide information and/or emotional, decisional or behavioural support for health problems using a digital platform for delivery such as a website (Alkhaldi et al., 2016).

and..

Blended care is a strategy that combines traditional face-to-face or centre-based services with digital or mobile technology strategies

Digital literacy refers to the basic information technology skills and literacy required to utilise and interact with others via digital technologies. These include communicating and navigating successfully using the Internet, computers, digital telephones and email.

Web 1 Content is website owner written and managed. Access is provided to users who choose to go to the site and receive information. Passwords can be used to restrict access to a selected target group. Web 1 represents the first iteration of the Internet.

Web 2 is defined as Internet based application for user-generated content that is an interactive component of web-based communication platforms. Social media channels are an example of web 2.

Mobile devices include mobile or cell telephones, smart phones, tablets and notebooks.

Telepsychiatry is frequently referred to as video-linked service between health services where the consumer or patient and/or carer is in one location, while the specialist mental health practitioner/s are in a separate location.

(Wilson in Procter et al, 2017)

Pause….Where is your phone?

Where is your smart phone? How often is it within reach? How convenient is it to use  day or night?

Can you accessing health information anytime you want?  Is it convenient? Desirable? Does it have any limitations? 

Explore the topic

  • In small groups of 3 or 4 use your smart device or laptop to gather relevant information about person centred E mental health care. You are free to explore any aspect of the topic area that you want to. You should explore a combination of best practice evidence and popular views.
  • Prepare to share your information with the whole group later.

Here are some links to prompt a start… you might find other interesting information as well… relax… explore the topic… enjoy the journey.

Pause…

Imagine for a moment that you are concerned about your partner or child who you think may have depression. Using the web browser of your choice, search for the Black Dog Institute and look for general information that describes depression and its treatment. What resources did you find? How suitable were they for providing basic information? Were they easy to find? What digital skills and hardware types did you need to access this information?As an E health care professional, how can you support people to gather the information useful to them to help them, and the people they care for? Discuss.

Build your knowledge

Pause…

Think back to a time when you have utilised online websites or apps to gain some health related information for your personal use. What was your experience of gathering web-based information like?

Were you satisfied that you located good quality information? How did you know you could trust the information? Or, were you suspicious about the quality of information you found? Did you find conflicting advice and if so, how did you decide which advice was correct?

If you were successful in your online search for health information, what digital literacy skills did you need to be successful? How did you develop those personal skills? How would you assist others without these skills to obtain good quality health information? As an E health professional, what codes of practice will you need to be mindful of to ensure that you provide safe advice about health to people seeking your professional assistance?

Share the information you have discovered as a small group with a larger group.

Together…discuss the concepts, interrogate the evidence base, and develop and synthesise knowledge about the topic.

Connect your shared knowledge to the practical settings where you work and study.

Pause…

Think back to the last time you called a service provider and were greeted by an automated phone service and menu.

How did you feel as you listened and made your way through the selections available?

Did you want to ask a question, but couldn’t? Did you want to talk about something slightly different to the categories offered? Did you feel like your enquiry was going to fit with the options available?

Or, would you have liked a different option that was not suggested? Did you fit into the menu available to you?

Did you mind having to select numbers and follow instructions? Was it convenient? (And if so; to who?) What emotions did you experience? Ambivalence? Frustration? Anger? Unintelligent? Confused? Happy? Helped? Content? Reflect on your experiences and feeling about your experiences?

Drawing forward your own learning from your own reflection on this type of experience, how do you think you would be able to assist a person with a mental health problem (or their carer) in this type of context? How will you engage with them positively? Can you see any barriers or enablers to automated services in a mental health context? Discuss with your peers.

Or…

Imagine you are planning a brief E mental health education intervention for a carer or a person experiencing an episode of depression using resources from Beyond Blue and/ or the Black Dog Institute websites, using mobile technology such as a smart phone.

What preparation will you need to do beforehand?

How will you convey the information and resources you have found to your clients?

How will you select appropriate information?

What education goals will you set?

How will you know your intervention has been effective and helpful?

How will you guide and facilitate the health learning experience?

Map your collaborative ideas…

  • In group discussion identify the practical skill set to apply knowledge in the clinical setting; innovation setting and research setting.
  • In the group discussion –  explore collaboration using a SWOT model strengths; weakness, opportunities; threats.
  • Think about a direct application to clinical e practice and person-centred mental health recovery. And, application to carer support and mental health promotion.
  • Consider application to safe practice, culturally inclusiveness and ethical care provision across the lifespan.

Synthesis: A community of practice…

Summarise your new applied knowledge that has been developed using group-based co-creative and transformative processes, for application within a community of practice.

My Samples include:

  • Design and user experience matters
  • Human connection matters
  • Safety matters
  • Do with (not to) matters
  • Evidence based practice matters
  • Practice informed evidence matters
  • Person, always first, and last.

But … what did you learn?

What are your top three take-aways from this session  that will inform the way you work towards person-centred e mental health care?

What else do you need to do/read/learn to strengthen your professional development for this topic area?

Start your transformative To Do list here:

Last lecture… Surviving & Thriving in the Nursing Academy

Last lecture… lessons learnt in nursing academia

 Surviving and thriving – the things you don’t get to say as often as you should

 For almost ten years I have had the fantastic opportunity to be employed as a nursing lecturer in Australia.

Now, as I prepare to move to a new research position at another university, in another country, I can look back and take some very real and hard won personal satisfaction from the fact that I have been able to play a significant part in contributing to the addition of many hundreds of registered nurses to the health workforce in Australia – and beyond. That is a very cool personal experience – something that has challenged and inspired me everyday of my academic life… the quality of care people receive from the nurses I have helped to educate is linked to the quality of the learning and motivation I was able to inspire in my students… These are the building blocks of the contemporary nursing workforce in Australia… I played a part. I am proud of my contribution, and thrilled to have had the opportunity! I continue to take the responsibility seriously… and my service to the professional progression of contemporary nursing education is evident in my journal and nursing textbook publications – a service to the profession.

Nurse Academics improve the world one student at a time

Each year I have helped to educate a new wave of nurses who in turn each go on to provide excellent quality nursing care to thousands of people around the nation and throughout the world. That is a very good feeling! Lots of people have lots of fantastic personal outcomes underpinned by the work my colleagues and I do together. Together we make a positive impact in the lives of many people, and we act to improve the world a little bit! It’s true… we do! But there are some battle scars that come along the way… it is a thankless, invisible job in many respects… and it is getting tougher as many students increasingly expect to be treated as online customers and the retail-style churn gets murkier year by year.

I leave this post wondering about future of nursing and worried for the well-being of the nursing academy. Fearful of the plummeting decline in the higher education sector in Australia, where funds are too little, and opportunities for scholars are too few. Where the casualization of the nursing academic workforce is the sad and unsustainable state of sordid affair that leaves everybody feeling rather disrespected the morning after.

The analogy was intended… the higher education system and funding provided to it, in Australia in 2016,… is, to not put to fine a point on it… it is… well it is, frankly… F@#$ED! I don’t think this is set to change… the political will for progress does not exist… and the ‘white poor’ will have an increasing sway in politics in the future. This demographic are less likely to value the higher education sector, seeing it as an arrogant sector, pompous, unpractical, ‘pie in the sky’… waste of public funds.

I understand… Ironically… my own background is a mixed ‘black and white poor’ stock… I understand the sense of discontent that many people have about us – from both side of the fence. We have Brexit in Britain… Trump in USA… Hanson and other in Australia… the democratic mood has diminished for the higher education sector generally. It is a shame… and before we point too many fingers… it should be noted it is a shame on us academics as well. We have failed in our duty to effectively communicate the value of what we do; what we contribute, and why it is important to society. We have let the team down corporately. We have failed to engage with the disgruntled and left out majority in the democracy we live and work in … we have failed to translate our knowledge in accessible formats for the general public to be able to digest– and this is the kick back.

Yearn to Learn

I leave my post… hoping that nursing students will yearn to learn more and shop less (that is, be more concerned with nursing and less concerned with the retail transaction in the university ‘mall’). And, that curriculum writers will remember to set aside sufficient time for learners to reflect and think about what they are learning and how they will be able to apply it in practice. To me at least, it seems we have all become too busy, pressed on every side and less scholarly in the rush. The rush is well known… it is the push to put ‘bums on seats’ … that is the bread and butter of the university financial bottom line. The equation is: More students = less substantive staff and quicker throughput… Trimesters. We call it things like adaptive change and we try to work ‘smarter’ but no matter how hard we try – keeping out of the red is a near impossibility for all universities. It is not a great environment for innovative thinking to flourish…

Preparing to leave this role has also caused me to think about what it has been like to be an early career and mid career academic… at lecturer level in a regional university. If I could, what advice I would give my 10 year younger self… starting out in academia and crossing over from clinical practice. Would I do it all again?

 Saying goodbye to a chapter in my academic life is an excellent opportunity to give a Last Lecture that hopefully distils some of my lessons learnt… and maybe sharing them will to assist others to survive a transition from clinical practice to academia… and to go on to thrive. Here are are few tips to share:

Cultural respect

First and foremost, Australia is Aboriginal and Torres Strait Islander cultural and traditional land. Colonisation has brought with it many challenges to first peoples. I think, nursing academics have a key role to play in the ongoing recovery journey for Indigenous people in Australia. For example, Nurse Academics can choose to role model an unconditional cultural respect that is authentic and genuine. In doing so, others can also learn the importance of integrating respect for country, place, people and culture into our curriculum, and ultimately as graduate attributes for all of our students. We can choose to position ourselves as caring people in a caring profession and lead cultural caring as well. This is critical for the social and emotional health and well-being of all people in the nation – we have a role to play – should be choose to accept the challenge. In particular, a trauma informed care approach to teaching and learning is vital. Therefore – my tip is…. start every class, commence every meeting, begin all collaborations with acknowledging Aboriginal and Torres Strait Islander Country and people… and then follow thorough with making and sustaining a culturally safe approach to every action, every plan and each decision. This is how the gap will close…

 Kindness

Be kind. Just be kind! Nurses are ideally active champions of kindness. In fact – lets go further…. Lets take on a movement of kindness leadership… lets develop expertise in the delivery of kindness… demonstrating professional kindness to all. Practice kindness. Hard – perhaps…yes! Possible… YES!

Nurses and nursing academics can sometimes be unkind to each other… Why do we offer kindness to those we care for professionally (our patients and clients), BUT, we don’t extend the same professional courtesy to each other? What harm could there be in being extra kind to our own?! We could do it! If we put our mind to it… if we wanted too…

How would kindness look in nursing academia? Well, one thing…the unheard would feel heard… there would be good logic, reason and evidence to support our teaching and learning practices and decision making… no one would be left out… everyone could thrive… no one would feel threatened by be success of others… the success of others is in fact a great cause for corporate celebration. And… we would all share a capacity to succeed and excel, personally and colalborately. Tall poppies would flourish – and would not look out of place – because they would have plenty of company from all the other tall poppies around them… and the discipline of nursing would flourish.

Our ideas, teaching and research would be more creative… and the people we care for would benefit too… So…. Be nice I say!! Be kind… let’s care for our own. Academia is a brutal enough place without us making it worse… let’s ‘kill it with kindness’.

Build Networks.

Establishing and maintaining professional networks beyond the department and institution are essential. And… it is hard to do, with the geographical disadvantage of a regional university location. But do it you must. Create conversations, discussions and collaboration beyond the department… across disciplines… across the nation… and across the world. If you are serious about being an academic and developing an academic career – then these relationships will be critical to future successes. Social media is the best tool to overcome the geographical distance. Here is the ‘How To’ guide for beginners…

Attend and speak at conferences… and make sure you put yourself ‘out there’… And when an opportunity arises to participate… Say ‘yes’ … often enough!

Don’t Stay Too Long

This is a tough one… because it often impacts personally as well as professionally. Academia (everywhere) is a harsh landscape – it is a bumpy ride. To survive – you have to move a bit. Be prepared to relocate or you will inevitably stagnate… don’t outstay your welcome.

In the new era of Post-Truth the prevailing wind seems to be toying with the idea of a fixed false belief that better things/people/others comes from faraway places… Don’t fall for that lie! Don’t stay too long… If things are starting to sour around you –chances are, it is probably not you… just that you are not new enough, exotic enough… and way too ‘local’ – taken for granted in a sense. We humans seem to be tantalised by the myth that the local known quantities are never good enough…there might be something better out there, somewhere… in the universe… So, rather than promoting and supporting our own people, we look for unicorns in faraway places with promises of great things… and then we live with our disappointment when that poor unsuspecting unicorn turned out to be much more ordinary than was hoped for. The delusions of it all! We think the grass is greener on the other side of the fence. The hard truth fact is: It’s not! But deluded, we persist in pursuit of the next exotic creature to grace our faculty doormat. So – don’t hang around too long… if you want to progress an academic career… you will need your CV to demonstrate international experience at some point… and a couple of universities will be handy to show a broad experience in academia. Stay long enough for an outcome… but not long enough to be hamstrung.

Take Risks

You will need to be prepared to take some risks… but the ones that you are OK to also take responsibility for … do your own risk analysis… some rules need to be challenged from time to time… some might need to be broken. If you have a good idea and you hit a brick wall… fine the work around. And – above all grab an opportunity when it arises. Some of them will be good! Occasionally, you will get it wrong – live with it and move on… grab the next good thing.

WriteWriteWrite

Did you read that headline carefully? Did you hear what I said? I’ll say it louder: WRITE. Publication is currency. So is a PhD – you need one… do it in the most timely way that you can – don’t delay the start…there will never be a better time. It is a horrid thing to have to endure – especially if you have a family and work as well… but you have to do it. You will be stuck, disgruntled, put-upon, and probably capsulized until you do…just get on an do it. And if you have one… write! Right?! Got it … Write.

Be Grateful

I’m thankful for many great colleagues and collaborations across almost 10 years at my university… I have embraced some good opportunities… I have taken some risks… and… I have learnt a great deal… I am grateful for all for the people that have shared their knowledge, enthusiasm and kindness with me… I am grateful that the university was established in my rural and regional home town… I am grateful for the environment in which I have lived nad worked … the country, the people… and especially my family who have been the backbone of my resilience… and have loved me unconditionally, no matter what – I am so, so, so grateful.

New Horizon

I am looking back with gratitude and looking forward with hope. On the horizon is a new country, and new research project, innovation in a greenfield area of research… it will be exciting and challenging – there will be hard work ahead… keep following to find out how landing in Denmark goes for an Aussie E Mental Health researcher…. Thanks Australia… Thanks Denmark… a new chapter begins…

If you are new to academia… I hope you have found a tip or two that will be relevant to you… and if you have been in academia for a while… I hope you are inspired to find new ways to thrive and opportunities to grab to enrich your career. Either way – the world needs us… people will always need nurses. We nurses are charged with the health promotion, recovery and well-being of all of the people in the world – it is a big ask… step up!

Would I do it again…? Yes… mostly… but… if only I had known…! and No… Somethings I have done… I would never do again… !

for more…. https://www.researchgate.net/profile/Rhonda_Wilson3

 

 

Rural #mentalhealth in Australia: Building on #strengths

  1. 62 mircoblogs about #Rural #mentalhealth in Australia and Building on our #strengths

  1.  related text: http://www.cambridge.org/au/academic/subjects/medicine/nursing/mental-health-person-centred-approach?format=PB
  1. #Rural is Multi dimensional concept…

  1. #RuralCulture… being from the bush…
  1. #RuralPlace… w/ psychological, emotional, socio-eco constructs
  1. #RuralIdentity… connection to place & people
  1. #RuralGeography…index & zones http://www.adelaide.edu.au/apmrc/research/projects/category/about_aria.html
  1. #Rural #MentalHealth – plan for 1/3 Australian population in #rural & #regional communities
  1. #mateship: Inter-relatedness #Caring #Connected #MutuallySupportive

  1. #mateship & #Rural lifestyle implications for #recovery in rural #mentalhealth
  2. #WaltzingMatilda A #rural #cultural anthem? http://www.poetrylibrary.edu.au/poets/paterson-a-b-banjo/waltzing-matilda-0026009
  1. #rural #mentalhealth #vulnerability: Rural itinerant #agricultural workforce

  1. #rural #mentalhealth #vulnerability – #loneliness & #isolation
  1. #rural #mentalhealth #vulnerability : Sleeping rough – homeless. No regular shelter
  1. #rural #mentalhealth #vulnerability: #FoodSecurity #access to #quality #foods & services
  1. #rural #mentalhealth #vulnerability: financial insecurity, petty crime, police & law matters
  1. #rural #mentalhealth #vulnerability: Loss of #hope for the future – suicide risk.
  1. #rural #mentalhealth #pressurepoints: volatile cconomic base – #agricultural influences #Walcha

  1. #rural #mentalhealth #pressurepoints: Limited access to public services & amenities
  1. #rural #mentalhealth #pressurepoints: Travel distance/time & transport & fuel
  1. #rural #mentalhealth #pressurepoints: #Environmental #vulnerability – drought, flood, rain, fire

22 #rural #mentalhealth #pressurepoints: Vocational thresholds & un/under employment

23 #rural #mentalhealth #pressurepoints: getting the stoicism balance right #nottoomuch #nottoolittle #Walcha

24 #suicide: 800,000+ people die by suicide each year – one person every 40 seconds

25 #suicide: in 2014 2,864 #Australians died

26 #suicide: Leading cause of death for #Australian #youth. (25% of total youth deaths)

27 #suicide: 65,000 people attempt suicide & 600,000 think about suicide each year #Australia

28 #rural #mentalhealth fact: 16% higher prevalence in rural communities

29 #rural #mentalhealth fact: Rural men more stoic – reluctant to seek help

30 #rural #mentalhealth fact: Rural women higher levels #depression & #anxiety

31 #rural #mentalhealth fact: Most vulnerable period 15-24 years

32 #rural #mentalhealth fact: Young rural men suicide rate double urban

33 #rural #mentalhealth fact: 85 yr+ rural men highest suicide rate

34 #rural #mentalhealth #risk: Low-socio-eco circumstances & Unemployment

35 #rural #mentalhealth #risk: Female gender and unmarried

36 #rural #mentalhealth #risk: Alcohol abuse

37 #rural #mentalhealth #risk: History of childhood sexual abuse

38 #rural #mentalhealth #risk: Poor social networks &/or small size of primary support groups

39 #rural #mentalhealth #strength: Longer duration of rural residency improves #QoL

40 #rural #mentalhealth #strength: Strong social connections

41 #rural #mentalhealth #strength: Close social proximity despite geographical distances

42 #rural #mentalhealth #strength: Open spaces – interaction with nature

43 #rural #mentalhealth #strength: Access to farm gate fresh food

44 #rural #mentalhealth #strength: Short travel times (locally)

45 #rural #mentalhealth #strength: Unique employment (ag/ mining)

46 #rural #mentalhealth #goingforward: improved political & social awareness

47 #rural #mentalhealth #goingforward: #DigitalTherapies – #ementalhealth

48 #rural #mentalhealth #goingforward: #EarlyIntervention & #Prevention

49 #rural #mentalhealth #goingforward: Progressive society for #LBGT. Reduction in #stigma #bullying #racism

50 #rural #mentalhealth #goingforward: Addressing historic issues eg royal commission sexual abuse

51 #threats #rural #mentalhealth: Reducing face-to-face services & amenities

52 #threats #rural #mentalhealth: Insufficient rural mental health public budgets

53 #threats #rural #mentalhealth: Unreliability of #internet services

54 #threats #rural #mentalhealth: #Ice, #cannabis, #drugs, #substance misuse

55 #threats #rural #mentalhealth: Economic & #rural commodity downturns

56 #threats #rural #mentalhealth: Environmental factors

57 #rural #mentalhealth#resilience #promotion: Enhancing and supporting social connection

58 #rural #mentalhealth#resilience #promotion:Invite men to seek help earlier

59 #rural #mentalhealth#resilience #promotion: Enhance & Support public & other transport infrastructure

60#rural #mentalhealth#resilience #promotion: Advocates & champions across rural sectors & politics

61 #rural #mentalhealth #resilience #promotion: Sustain self-care; satisfaction in life & hope generation

62 #rural #mentalhealth #resilience #promotion: drive & support #Digital literacy & #ementalhealth innovation

 

#EMentalHealth: Digital interventions blended with traditional care.

 

…what is E Mental Health?

images

E Mental Health has been around for the last 50 years, perhaps more, in a rudimentary fashion using two-way radio and landline telephones. The idea of consulting with, and supporting, patients (and their families) using communication technology is well established. We have been using telephone services in mental health for many years, but in recent times, E Mental Health has snowballed to include a wide range of electronic and digital technologies enabling mental health promotion, early intervention and longer-term treatments in both stand-alone and blended care formats.

Increasingly, it is seen as a viable and cost effective strategy to integrate or blend care within a comprehensive suite of mental health service delivery options, making it possible to help more people at a time and place of convenience to them (Wilson R. L. & Usher, 2015). A wide range of digital interventions are emerging, however not all of them has been validated for safety and efficacy in clinical trials. Never-the-less, it is known that positive engagement in mental health interventions (especially where behaviour change is required) is improved where technology-based strategies are included in either standalone or blended therapies (Alkhaldi et al., 2016). Digital interventions can be described as “programs that provide information and support – emotional, decisional and/or behavioural – for physical and/or mental health problems via a digital platform” (Alkhaldi et al., 2016; Bailey et al., 2010).

E Mental Health is expanding into new and exciting areas of practice, and for clinicians and health researchers, this is a particularly dynamic time. The general community are engaged and ready to use E Mental Health innovation (Fox & Duggan, 2012). More than that… people now expect to find useful mental health information, support and even treatment in digital formats (Fraser, Randell, DeSilva, & Parker, 2016). People expect to access E Mental Health in a range of forms as simply and quickly as pulling their smart phones out of their pockets. Increasingly, a ground swell exists for self-care E Mental Health and this is gaining widespread popularity (Alkhaldi et al., 2016). Many people prefer to receive, information, guidance and even treatment in the privacy, and comfort of their own homes where they remain connected to their place and daily practical life competencies that underpin their optimal wellbeing (Bissell, 2013).

The 21st Century E Mental Health reality is that health care professionals can deploy a virtual mental health clinic in the pocket, handbag, or backpack of the majority of people in the developed world, and for many people in developing countries also (Brusse, Gardner, McAullay, & Dowden, 2014; Wilson, Ranse, Cashin, & McNamara, 2013). The global opportunity that is available by using the personal Internet connected smart devices of individuals everywhere has enormous potential and capacity to promote mental health, and to reduce the burden of global mental illness (ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union., 2012; Proudfoot, 2013). These are exciting times.

3 main categories for E Mental Health services:

  • Voice/Text/SMS
  • Video
  • Web 1 & 2.

voice & text…

            examples…

  • Two-way radio UHF services where mobile or cell phone coverage is poor (for example, Royal Flying Doctors Service in remote regions of Australia).
  • Call centre-based services to triage and arrange intake or referral to individuals seeking entry to mental health care services (for example NSW Health free call numbers in Australia) (Elsom, Sands, Roper, Hoppner, & Gerdtz, 2013).
  • Call centre-based services to crisis mental health help lines (for example Australian services such as: Lifeline, Suicide Call Back Service, Kids Help Line). Similar services are available in most countries where free public mental health care services/insurance also exist.
  • Most countries have an emergency service free call telephone number such as 000 in Australia, 911 in USA, 112 in Europe and 999 (or 112) in the UK.
  • Mobile/cell phone SMS or text-based services (“Nancy Lublin: Texting that saves lives,” 2012).

images (2)

video…

            examples…

  • Telepsychiatry – frequently refered to as video links between health services where the consumer or patient and/or carer is in one location, while the specialist mental health clinician/s are in a separate location. A synchronised time is arranged to make a private video consultation link-up. This allows people to receive specialist care without the need to travel to a far away appointment in a distant location (for example Queensland Health (Queensland Health., 2013; Statewide telehealth services., 2013) and )
  • More recently Skype has provided a platform that enables flexible video based consultation and added an element of convenience and simplified technology.

web 1 & web 2…

            examples…

  • Email usage and web browser literacy is now generally considered to be a basic life skill for adults, where an integration of web literacy develops as people are able to explore, build and connect relevant information that is useful to them and for solving a range of problems from a self help perspective. For example: Browser search engines such as Google and associated free email host services such as gmail have provided a virtual and digital context where people are more able to search for health information aligned with their health needs and specific health question.
  • Web 1 has provided a platform for health care professionals to develop static information and education resources for the general public (for example: beyond blue, black dog), and also website based intervention tools. For example Cognitive Behavioural Therapy (“myCompass. Introductory video,” 2010) and Mindfulness Based Therapy.
  • E Mental Health electronic patient records such as the European E health action plans and in Australia (Australian Commission on Safety and Quality in Healthcare., 2016).
  • Call centre-based services have been able to add value to their telephone services, by providing extra general information on website connected to their services so that they can support callers further. (For example: Lifeline)
  • Web 2 has expanded the options available even further by integrating all other options with a synchronous real time, and asynchronous convenient times, social media enhanced interactive experience that is particularly convenient to the general population, and it is this element of E Mental Health that offers particular promise as new service and interventions are developed.
  • Smart devices, and especially smart phones, facilitate the opportunity to utilise apps to enhance the mental health service portfolio, with many apps currently available as information or treatment services.
  • Personal electronic accessories such as fitness monitoring devices (eg fitbit or the apple watch) that sync activity levels, such as heart rate, calorie consumption, with smart device diary tools to monitor health characteristics and behavioural change. Fitbit has demonstrated effectiveness as a monitoring tool to enhance engagement in self-care and promoting health and wellbeing generally. The integration of these personal monitors into health care is gradually occurring.
  • Gamification in E Mental Health, enhancing engagement in mental health self-care, and gaming-based interventions is an area of particular growth. Gamification introduces a fun and engaging way to interact with health promotion, digital intervention and to foster behavioural change with the added incentives and motivation of providing rewards for efforts. Some gamification is simple and brief such as gif files that prompt and guide breathing to assist in reducing the experience of panic or anxiety.
  • More advanced gamification is used to connect with various populations, for example, young people. Integrating gamification software strategies into mental health promotion and strategies will target at risk populations.
  • Social media is a useful platform for teaching the public, student health professionals and less engaged experienced clinicians about mental health information and clinical skill development. We know that many health professions students prefer to gain their discipline information for social media such as Facebook (Usher et al., 2014). We also know that a growing number of health professionals are using social media to create virtual communities for research, practice, knowledge exchange and mentoring purposes.

blended capacity…

The common usage of personal smart phones and access to computers and other smart devices has driven a level of integration so that we are now in an era where voice, video and web-based resources are available, and often in a blended format so that all three can be use simultaneously and either in synchronous or asynchronous formats. This provides service users and service providers with a level of flexibility and convenience not seen previously.

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commercial & social enterprise influence in the E Mental Health arena…

Plenty of innovation in the field of E Mental Health is occurring at a rapid pace, with commercial and social enterprises quick to respond to the global appetite to address mental health problems generally. There are many apps and websites to choose from – some with costs, others free to access. This dynamic has both risks and benefits associated with it.

benefits…

  • A general population wide awareness and expectation about accessing mental health information and support in an electronic environment.
  • Populations skilled and literate in the use of electronic devices and digital technologies such as apps, web site navigation, email and social media.

risks and limitations…

  • The trustworthiness, reliability, dependability and credibility of many E Mental Health activities in the commercial and social zones are not known because E Mental Health research and development occur at a slower pace than the commercial and social environment, and with a rigorous process to demonstrate efficacy and patient safety. Thus, health service providers and clinicians are reluctant to engage in E Mental Health initiatives with out best practice rigour to support their practice.
  • Clinical trials take a significant amount of time, planning, design and testing to underpin evidence to support safe practice. In the context of the rapid pace of change in the E environment generally, this poses a challenge.
  • Not all clinicians are keen adopters of social media generally. Thus a digital literacy and skills base has not dominated the health environment generally to date. The mental health workforce is aging in the international sphere, and as younger and digitally literate workforce enter the mental health professions they will bring with them the ease and comfort of existing and operating in the various web environments (Wilson et al., 2013).

opportunities for safe E Mental Health development…

E Mental Health holds great promise for mental health care now, and into the future. There are some gaps at present, and there is a significant need for ongoing research to develop practice-ready tools to contribute to a blended care delivery system (Fraser et al., 2016). Blended care includes elements of face-to-face and online or electronic components of clinical mental health care.

Mental health clinicians and researchers need to develop and refine their skills in the use of e health care technologies – especially in regard to web-based tools, apps and social media (Wilson et al., 2013). Encouragingly, students in the health professions indicate that they are likely to have a strong grasp of electronic health care and information transfer because they bring pre-existing web-savvy skills to their pre-qualification studies (Usher et al., 2014).

Governments and funding bodies increasingly anticipate the incorporation of strategic E Mental Health care into health service delivery systems, because it aligns with economic business plans and population distribution plans (Department of Health., 2015; E-mental health strategy for Australia, 2012; European Commission, 2012).

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in summary…

  • E Mental Health is not new, but it is expanding at a rapid pace, driven by consumer demand and heath service financial constraints to deliver more services with limited budgets
  • Three main avenues exist for E Mental health: Voice/ text; video; and Web 1 & 2.
  • Opportunities exist to build safe E Mental Health into the future as research and development collaborate with willing practitioners to create a evidence base to support best practice in the E Mental Health field.

References

Alkhaldi, G., Hamilton, F. L., Lau, R., Webster, R., Michie, S., & Murray, E. (2016). The effectiveness of prompts to promote engagement with digital interventions: a systematic review. Journal of Medical Internet Research, 18(1), e6. doi:10.2196/jmir.4790

Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health.   Retrieved from http://www.safetyandquality.gov.au/our-work/safety-in-e-health/

Bailey, J., Murray, E., Rait, G., Mercer, C., Morris, R., Peacock, R., . . . Nazareth, I. (2010). Interactive computer-based interventions for sexual health promotion. Cochrane Database of Systematic Reviews, 9(CD006483). doi:10.1002/14651858.CD006483.pub2.

Bissell, D. (2013). Virtual infrastructures of habit; the changing intensities of habit through gracefulness, restlessness and clumsiness. Cultural Geographies, 0(0), 1-20.

Brusse, C., Gardner, K., McAullay, D., & Dowden, M. (2014). Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review. J Med Internet Res, 16(12), e280. doi:10.2196/jmir.3614

Department of Health. (2015). e-Health.   Retrieved from http://www.ehealth.gov.au/internet/ehealth/publishing.nsf/content/home

E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/D67E137E77F0CE90CA257A2F0007736A/$File/emstrat.pdf.

Elsom, S., Sands, N., Roper, C., Hoppner, C., & Gerdtz, M. (2013). Telephone survey of service-user experiences of a telephone-based mental health triage service. International Journal of Mental Health Nursing, 22, 437-443.

European Commission. (2012). eHealth Action Plan 2012-2020 – Innovative healthcare for the 21st century. Retrieved from Brussels: file:///Users/rhondawilson/Downloads/eHealthActionPlan2012-2020.pdf

Fox, S., & Duggan, M. (2012). Mobile Health 2012: Half of smartphone owners use their devices to get health information and one-fifth of smartphone owners have health apps Retrieved from California Health Care Foundation: E Mental Health.docx

Fraser, S., Randell, A., DeSilva, S., & Parker, A. (2016). Research Bulletin: E-mental health: the future of youth mental health? Retrieved from Orygen Youth Health: https://orygen.org.au/Our-Research/Research-Areas/Online-Interventions-and-Innovation/Orygen-Research-Bulletin-E-Mental-Health.aspx

ICT Data and Statistics Division Telecommunication Development Bureau Geneva Switzerland International Telecommunications Union. (2012). Mobile cellular subscriptions per 100 inhabitants, 2001-2011 (Excel Spreadsheet) Retrieved from http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.

. from Telecommunication Development Bureau Geneva, Switzerland: International Telecommunications Union. http://www.itu.int/ITU-D/ict/statistics/material/excel/2011/Mobile_cellular_01-11.xls.

 

. myCompass. Introductory video. (2010). In B. D. I. m. program (Producer). Australia: Black Dog Institute.

Nancy Lublin: Texting that saves lives. (2012, April 2012). TED talks. Ideas worth spreading. Retrieved from http://www.ted.com/talks/nancy_lublin_texting_that_saves_lives.html

Proudfoot, J. (2013). The future is in our hands: The role of mobile phones in the prevention and management of mental disorders. Australian and New Zealand Journal of Psychiatry, 47(2), 111-113.

Queensland Health. (Producer). (2013, 7 March 2013). Telehealth. Retrieved from https://www.facebook.com/notes/queensland-health/telehealth/379845328790222

Statewide telehealth services. (Writer). (2013). Extending the reach of clinical health services throughout Queensland . In Q. health (Producer). Australia: Queensland health.

Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004

Wilson R. L., & Usher, K. (2015). Rural nurses: A convenient co-location strategy for rural mental health care of young people. Journal of Clinical Nursing, 1-11. doi:DOI: 10.1111/jocn.12882

Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003

 

Future Nurses: resilient, transformative & tech savvy

Practice-informed nursing: The future of transformative nursing education and research in a technological context

steth and ecg

Three significant factors will impact on the future of nursing education and research in Australia

  1.  Entrenchment of a culture of patient safety among practice-ready graduates while offering transformative educational experiences to nursing students and building resilient communities. Rural and regional communities, Indigenous people, and international inclusiveness and connectivity will be particularly important.
  2.  Entrepreneurial nursing academics will be pivotal in developing innovative ways to fund practice and research projects; deliver quality-learning programs; and produce a strategic mix of research outputs. This is critical because of cuts to funding across the higher education sector and increasing competition for research grants.
  3. Capitalising on E Health – using the term broadly to cover not only storing, retrieving, maintaining and sharing patient records safely and effectively, but also electronic health service delivery assisted by communications technologies, such as web-conferencing, internet-based interventions, and the use of apps and social media. And there’s also E Health in academia – the way that the technologies are revolutionising the teaching, learning and research environment for nursing. Nursing academics’ expertise in E Health technologies will undoubtedly need to expand in the future.

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transformative practice informed patient safety

The health industry expects universities to produce nursing graduates who are practice-ready and proficient in delivering quality health care where patients are safe, health risk is reduced, and deterioration is detected and responded to quickly. The graduates must be prepared for the high acuity of workplaces in the health sector, and must possess the indispensable attribute of resilience. Industry also expects graduates to be skilled in collaborative teamwork and capable of leadership and supervision early in their careers (Australian Commission on Safety and Quality in Health Care, 2010; Australian Institute of Health and Welfare, 2014; NSW Health, 2013).

A new era in the nursing discipline is dawning where transformative models of service and care are prioritised. The transformative process surpasses the traditions of ‘evidence-based practice’ and ‘life-long learning’, which frequently uses ‘time-spent’ as a metric to determine learning outcome.

Instead, future nursing needs contemporary continuous transformative learning, and practice-informed research using continuous models that are more flexible and nimble, in order to enhance capacity to adapt to rapid changes. Preparing students to be practice-ready has become increasingly challenging within the traditional three-year degree program, where specialty themes compete for inclusion. There is a need for innovative and entrepreneurial practice-informed teaching and learning to invigorate future curriculums, in conjunction with a balanced approach to practice-informed research agendas.

Postgraduate courseware will need to align with, and adapt to, market forces. In Australia, this includes addressing the changes announced by government to create Primary Health Networks and Health Care Homes, and ensuring the supply of qualified nurses to fill posts in these national centres (for example, Credentialed Mental Health Nurses). Advocating for appropriate reimbursement of specialist nurses will be a critical driver of postgraduate education (Australian College of Mental Health Nurses, 2013).

nurse entrepreneurialism in higher education

Funding for the higher education sector has been dwindling in recent years leading to major budgetary challenges, particularly for regional universities. Popular, high-enrolment courses like Bachelor of Nursing  will continue to be important and strategic contributors to the overall university budgets.

International university ranking analysts suggest that “strongly motivated academics can offset to some degree limited funding” (Williams, Leahy, de Rassenfosse, & Jensen, 2016). Actively seeking collaborations will be vital to ensuring research funding success at the highest level, and so will serious attention to grantsmanship.

Nursing curriculum, with its expensive practicums, will undergo closer fiscal scrutiny in the future. So will other teaching related expenditure, with imperatives to maintain industry accreditation, to provide quality educational experiences for students, to have genuine consumer participation in curriculum design, and to incorporate digital and simulated pedagogies while managing cost effectiveness.

A particular challenge for nursing is to improve the impact of nursing research generally. Co-investigative nurse membership of collaborative interdisciplinary research teams has been important. A newer challenge is to move towards a position of excellence in nurse-led health research. New opportunity exists to do this, with the Australian Research Council looking to widen the definition of measurable impact to include category 2 and 3 grants, and with impact metrics increasingly linked to Google open access outputs, and international linkages including co-authorship (Williams et al., 2016).

Nurse researchers will need to be grant-ready and this includes building track record in grant success, and generating publications from their research. Concurrently, nursing scholars will need to develop industry and research linkages (including international higher degree research student intakes), together with the technological skills to generate outputs in digital domains.

safe and effective e health innovations

State and Federal governments are turning their service delivery focus and funding streams toward E Health services to meet growing expectations across the Australian consumer population (Australian Bureau of Statistics, 2013; Australian Commission on Safety and Quality in Health Care, 2015). For example: digital gateways for triaging and accessing health care service provision (Department of Health, 2015), managing patient health records, and delivering, monitoring and evaluating health interventions (Christenson & Petrie, 2013; Department of Health, 2016; Department of Health, 2015; E Mental health strategy for Australia, 2012; Keast, 2016).

E Health skills will need to be recognised as a core competence in future nursing curriculums (Australian Commission on Safety and Quality in Health Care, 2015). The rise of E Health presents opportunities for nursing  with improved digital pedagogy learning design systems to produce nursing graduates who are practice-ready for the new and evolving practice domain of safe E Health. This has particular relevance for including and servicing rural and regional communities.

The nursing academy in Australia is trending against the odds. Nationally, enrolments are high, outputs and impact are strengthening despite dwindling higher education budgets for the discipline. Nursing academics will continue to drive the Australian nursing discipline into the future as they transform their focus towards practice-informed teaching and learning, practice-informed research integrated with international connectivity, and stronger collaborative relationships with the health sector and wider society.

vital signs monitor

refererences

  1. Australian Bureau of Statistics. (2013). Internet Activity, Australia, December 2012. (8153.0). Canberra: Australian Bureau of Statistics. Retrieved from http://www.abs.gov.au/
  2. Australian College of Mental Health Nurses. (2013). A Survey of Credentialed Mental Health Nurses working in the Mental Health Nursing Incentive Program.
  3. Australian Commission on Safety and Quality in Health Care. (2015). Australian Commission on Safety and Quality in Health Care Annual Report 2014/15. Retrieved from http://www.safetyandquality.gov.au/
  4. Australian Commission on Safety and Quality in Health Care. (2010). National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration. (pp. 1-24). Sydney: Australian Commission on Safety and Quality in Health Care (ACSQHC).
  5. Australian Commission on Safety and Quality in Healthcare. (2016). Safety in E Health. Retrieved from http://www.safetyandquality.gov.au/
  6. Australian Institute of Health and Welfare. (2016). Primary Health Network (PHN) data. Retrieved from http://www.aihw.gov.au/
  7. Australian Institute of Health and Welfare. (2014). Australia’s Hospitals 2013-14. Retrieved from Australian Institute of Health and Welfare:http://www.aihw.gov.au/
  8. Australian Research Council. (2016). 2015-2016 State of Australian University Research ERA National Report. Retrieved from: http://www.arc.gov.au/
  9. Best, O. (2015). The cultural safety journey: An Australian nursing context. In O. Best & B. Fredericks (Eds.), Yardjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (pp. 51-73). Port Melbourne: Cambridge University Press.
  10. Christenson, H., & Petrie, K. (2013). Information technology as the key to accelerating advances in mental health care. Australian and New Zealand Journal of Psychiatry, 47(2), 114-116.
  11. Department of Health. (2015). Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services. Canberra: Australian Government Retrieved from http://www.health.gov.au/
  12. Department of Health. (2016). Health Budget 2016–17. Retrieved from http://www.health.gov.au/
  13. Department of Health. (2015). e-Health. Retrieved from http://www.ehealth.gov.au/
  14. E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/
  15. Godbold, N., & McCaffery, K. (2015). Improving care by listening: care communication and shared decsion-making Communicating quality and safety in health care (pp. 164-175). Port Melbourne: Cambridge University Press.
  16. Keast, K. (2016). How technology will advance nursing practice. Retrieved from http://healthtimes.com.au/
  17. Little, F., O’Brien, A., Gray, M., Wilson R. L., & Finn, A. (2015). Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW. Final Report: 20th November 2015. Retrieved from Hunter & Central Coast Interdisciplinary Clinical Training Network:
  18. NSW Health. (2013). Policy Directive: Recognition and Management of Patients who are Clinically Deteriorating. (PD2013_049). Sydney: NSW Ministry of Health.
  19. Usher, K., Woods, C., Casella, E., Glass, N., Wilson R. L., Mayner, L., . . . P., I. (2014). Australian health professions student use of social media. Collegian, 21(2), 95-101. doi:10.1016/j.colegn.2014.02.004
  20. Williams, R., Leahy, A., de Rassenfosse, G., & Jensen, P. (2016). U21 Ranking of National Higher Education Systems 2016. Retrieved from http://www.universitas21.com/
  21. Wilson, R. L., Ranse, J., Cashin, A., & McNamara, P. (2013). Nurses and Twitter: The good, the bad, and the reluctant. Collegian(0). doi:http://dx.doi.org/10.1016/j.colegn.2013.09.003