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Background Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. Method A focus group interview model was used, with a semi-structured interview guide initiating group discussions. A thematic analysis methodological approach was selected to analyse the data. Results This paper reports on the theme of Service Delivery, which has three sub-themes of Availability; Distance; and Individual Access. The key findings are presented and supported by the use of exemplar quotes. Conclusions This research indicates a poor intersection of general and specialist services is inhibiting post-parental transitional care for rural people. Simply allocating money to the individual does not resolve the issues, and the interface between different services needs to be better considered at government level. Refereed/Peer-reviewed

Intersecting gender and other social inequalities are pertinent to women’s mental health across the life course. Gendered violence and other forms of gender inequality in particular play a key role in the higher burden of psychological distress carried by young women. However, the context of gendered violence is often minimised or overlooked entirely when young women seek help or advice around mental health concerns. This is especially the case for young women under the age of 30 years. This paper reports on a research study exploring how young women in Australia understand their mental health, and the scope for new approaches to support that better address their needs. A qualitative survey undertaken with 52 Australian young women was used to explore the nature of their mental health experiences, sought to learn about the strategies they used when experiencing poor mental health and the scope for mental health peer support as an alternative approach to intervention. Responses from a diverse group of young women demonstrated that they understood the role that gendered violence and gender inequality played in their mental health. Findings point to the risk of slippage between young women’s understandings of their lived experience and those of traditional service providers, demonstrating the risks associated with minimising or ignoring of the gendered nature of young women’s mental health problems. Refereed/Peer-reviewed

This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention.

BACKGROUND: Depression is a major public health concern of global significance. The illness diminishes overall quality of life and has been associated with significant distress and disability in physical, interpersonal, and social role functioning. Over the past few decades, a consensus has evolved that cognitive behavioural therapy (CBT) can be an effective treatment for depression in older adults; however, little attention has been given to its effect on them. AIMS: The purpose of this review was to examine the current use of CBT and its effect on older adults with depression.Method: A web-based literature search was performed to identify original research articles published from 2000 to 2013 using a three-step search strategy. RESULTS: Evidence indicates that cognitive behavioural therapies are likely to be efficacious in older people when compared with treatment as usual. This is consistent with the findings of several systematic reviews and meta-analyses undertaken across a wider age range.Conclusions: Given that many older adults with depression are reluctant to accept antidepressant medication or unable to tolerate their side effects, CBT can be used as an option in treating depression in older adults. Refereed/Peer-reviewed

In conceptualizing vulnerability, it is common for researchers to assume that some participants are more vulnerable on the basis of their membership of a particular group or because they exhibit particular characteristics. Older people are often viewed as inherently more vulnerable by ethics committees and the ethical guidelines committees construct. Because age alone does not confer or cause vulnerability, risk of harm to older research participants is not purely associated with their intrinsic connection to a vulnerable group, and classifying older research participants as vulnerable may not necessarily protect them from harm. Drawing on the preliminary findings of a qualitative study of older people who had survived a suicide attempt, we reflect on how the specific context of our study had the potential of framing older people as vulnerable, and describe ways in which these were managed and resolved. Specifically, we discuss potential for harm through the ethical principles of coercion and distress.

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.

This paper reviews current literature on succession planning for mental health nurse practitioners (NPs) and discusses a model of succession planning that is underpinned by principals of leadership development, workforce participation and client engagement. The paper identifies succession planning as a means of managing a present and future workforce, while simultaneously addressing individual and organizational learning and practice development needs. A discussion of the processes attendant upon sustainable succession planning - collegial support, career planning and development, information exchange, capacity building, and mentoring is framed within the potential interrelationships between existing NP, developing NP and service directors and/or team managers. Done effectively and in partnership with wider clinical services, succession planning has the potential to build NP leadership development and leadership transition more broadly within mental health services.

This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention.

Older adults are at higher risk of dying by suicide than younger age groups, particularly where a previous attempt has been made. The aim of this study was to identify and review quantitative and qualitative research studies of attempted suicide in older people published between 2005 and 2014. Of the 128 relevant studies identified 23 were included for review. Content analysis was employed to extend conceptually the interaction between biological, psychological and social factors in the context of the suicidal process. The perspectives of older people who have survived a suicide attempt are critically needed to inform future prevention and intervention strategies, specific to the sociocultural frameworks within which they operate. Refereed/Peer-reviewed

Background: Pharmacotherapy is commonly a frontline treatment for depression in the long-term care of older adults, however some people continue to experience adverse effects after therapy has ceased. A growing body of evidence suggests alternative forms of treatment for depression are warranted, though little attention has been given to clinician and consumers' views and perspectives of treatment. Aim: The purpose of this study was to explore clinician and consumers' views and perspectives of CBT treatment for older people with depression. Method Focus groups (n=l) and individual interviews (n=4) were conducted with mental health professionals (n=6) and older consumers (n=2). Results Thematic analysis revealed a range of insights embedded within three major themes: (i) Understanding and experience of CBT; (ii) Challenges and barriers to CBT uptake, and (iii) Delivering CBT - when and by whom? Discussion Older people can positively influence their depressive symptoms by changing their behaviour and thought processes through engagement with CBT interventions. CBT is flexible and has the potential to offer longer-term relief of depressive symptoms experienced by older people. Mental health nurses may be uniquely situated to incorporate elements of CBT into their treatment and care of older people with depressive illness. Refereed/Peer-reviewed

Background: Suicide in older people is a significant public health issue with a predicted future increase. Contemporary research directs considerable attention toward physical, mental, and social risk factors that contribute to suicidality in older people; still, little is understood about the fundamental meanings that older people in suicidal crisis attribute to these factors. Aims: The aim of this qualitative study was to describe, analyze, and compare counselors' and older peoples' perceptions of the suicidal crisis during an emergency telephone conversation. Conclusions: An explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person's life. This research has begun to capture and illuminate how telephone counselors can deliver effective crisis intervention as older people struggle and make meaning through their suffering. Methods: Data collection consisted of individual interviews with telephone counselors (N = 7) working within an emergency mental health triage service, and listening to telephone calls (N = 14) received by the service responding to people aged 65 years and over in suicidal crisis. Triangulation of the two data sets resulted in the emergence of three key themes. Results: We found (1) congruence in the way risk factors were perceived by counselors and communicated during telephone conversations, (2) dissension between counselors' perceptions of end-of-life issues and older people's feelings of ambivalence about wanting to die and not knowing what to do and (3) the need for working side-by-side with the older person, exploring acute changes and immediate capacity for change. Refereed/Peer-reviewed

Effective risk assessment and risk management is an important component of clinical mental health practice and is vital to people in crisis and at risk of an adverse outcome. This discussion paper reflects on key findings from a symposium addressing clinical risk assessment and risk management processes and methods. The focus of the symposium centred on the importance of shared learning in clinical practice to enable practitioners to reflect and learn from one another in relation to the complexities of modern-day mental health practice and the implications of the various mental health reform agendas to the provision of clinical care and treatment. The symposium provided an opportunity for clinicians to critically present and discuss risk assessment and risk management practices in an endeavour to develop a systematic approach to the effective assessment and management of suicide, aggression and violence in a range of mental health settings. Key findings from the symposium are discussed against a backdrop of contemporary literature in the field and form a practical framework for the assessment and management of risk regarding suicide, aggression and violence. Refereed/Peer-reviewed

Summary Introduction Evaluating and improving a model of nursing care is a fundamental part of clinical practice improvement. While Australian nurses are showing increasing interest in improving models of care delivery, more research is needed that addresses and articulates the processes attendant upon evaluating, re-designing and implementing improvements to the provision of nursing care. Providing nurses with an open opportunity to plan, act, observe and reflect on their practice promotes successful partnerships between academics and clinicians. Aim The aim of this study was to evaluate and improve the model of nursing care delivery to patients in a general surgical ward using participatory action research. Method Researchers conducted non-participant observations ( n = 9) of two hours duration across the 24 h period. Focus groups ( n = 3) were used to share non-participant observation data with staff, providing them with an opportunity to reflect on their practice and explore possible solutions. Data was collected in 2008–2009. Results Two main problem areas were identified as impeding the nurses’ ability to provide care to patients: (i) practices and behaviours of nurses and (ii) infrastructure and physical layout of the ward. An overview of issues within each problem area is presented. Conclusion Shifting the focus of task-centred care towards a more patient-centred care approach, results directly in improvements in resource utilisation, improved cost-effectiveness and job satisfaction for nursing staff. New ways of thinking about nursing processes and systems, workflow design and skill allocation will guide hospital administrators and managers in the effective and efficient allocation of nursing work in similar settings.

A number of significant challenges face graduate mental health nurses entering the workforce. In response, Transition to Practice programs have been promoted as a potential strategy for improving recruitment and retention within the mental health system. This review explores the experience of transition for mental health nurse graduates and identifies key aspects of Transition to Practice programs that facilitate the transition to practising professional. A comprehensive review of qualitative research, which sought to provide insight into the experience of transition for graduate mental health nurses, was conducted. Nine studies were identified through a search of MEDLINE, CINAHL, PsychINFO, PsychArticles, Psychology, AMED, EMBASE and Health Source: Nursing/academic edition. Findings showed a disparity between undergraduate perceptions of the mental health nurse role and what is actually observed during placement, highlighting the need for the positive contribution of preceptors and mentors within a transitional support model for newly graduated mental health nurses.

Midline catheters have many advantages for chronically ill patients needing up to six weeks intravenous therapy and medications, and when inserted in a sterile environment and correctly monitored and maintained, have a significantly lower association of infection and thrombus than previously suggested. Furthermore, there is a reduction in central collateral vessel formation from incursions into the superior vena cava, associated with peripherally inserted central catheters. Midline use was examined in a cystic fibrosis control group. Lines were checked daily until removal. All midline catheter tips were sent for culture on removal and data from 42 midlines placed in 2006 were retrieved from the hospital scientist for analysis. Twenty-seven inpatients with cystic fibrosis were identified and informed of the trial and possible risks of midline use. Outcome variables included infection and thrombus rates. On conclusion of the trial, data demonstrated both zero infection and thrombus rates in the study patient population. Midline catheters were monitored for a further 12 months following conclusion of the trial and infection rates continued to be below 1% and thrombus rates lower than 2%. In the specified group, the parameters of use for midlines fit with international cystic fibrosis intravenous antibiotic protocols currently adhered to. The study has begun to generate evidence to inform clinical practice, improve patient outcomes and supports the role of the specialist nurse in implementing midlines for cystic fibrosis patients. Refereed/Peer-reviewed

This paper reviews current literature on succession planning for mental health nurse practitioners (NPs) and discusses a model of succession planning that is underpinned by principals of leadership development, workforce participation and client engagement. The paper identifies succession planning as a means of managing a present and future workforce, while simultaneously addressing individual and organizational learning and practice development needs. A discussion of the processes attendant upon sustainable succession planning - collegial support, career planning and development, information exchange, capacity building, and mentoring is framed within the potential interrelationships between existing NP, developing NP and service directors and/or team managers. Done effectively and in partnership with wider clinical services, succession planning has the potential to build NP leadership development and leadership transition more broadly within mental health services.