Download - Andrea Hall - Australian Catholic University
Andrea Hall
The Victorian Reducing Restrictive Interventions Project (RRI) 2013-2014 Aimed to support the reduction, and where possible
elimination, of restrictive interventions in Victorian mental health services (MHS) and emergency departments (EDs)
Assist services to comply with the new legislative requirements of the Victorian Mental Health Act 2014 (the Act)
Assist MHS & EDs to work together to develop and implement Local Action Plans (LAP) for competitive funding
Emergency Department (ED) ObjectivesIdentifying: What restrictive interventions are being used in ED’s How & where these interventions are being recorded How data is subsequently used for QI purposes
In addition we were scoping what: Policies, Procedures and Pathways were in place Nurses working on the floor with MH patients felt was needed
to bridge the gap of skill and training deficits Training opportunities exist in EDs relating to this subject Current level of effectiveness of relationships between EDs &
MHS
Survey data collection process/demographics
230 responses (nurses)
16/22 Victorian gazetted EDs represented
5 rural EDs
11 Metropolitan EDs
Majority of respondents were Registered Nurses who work on the floor with patients
Emergency Department Survey findings
Emergency Nurses:
Reported not feeling adequately trained in terms of mental health presentations to the ED
Want more education regarding mental health presentations
Very few identified receiving informal or formal support from their affiliated MHS
Reported using high levels of physical and mechanical restraint
Reported confusion around data recording, reporting and use for quality improvement
Evidence to support the need for further education
Rising number of presentations to EDs Australia wide(Department of Health 2013)
The Victorian Mental Health Act 2014 emphasises the need to provide care in the least restrictive environment possible
(Victorian Mental Health Act 2014)
Australians reporting a history of a mental and behavioural health condition has increased to over 3 million
(Australian Bureau of Statistics 2012)
What is trauma Informed Care (TIC)?
Trauma-informed care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological and emotional safety for both providers and survivors and that creates opportunities for survivors to rebuild a sense of control and empowerment
(Hopper et al., 2010)
Why is TIC important?
Hospitals can evoke memories of traumatic experiences for some patients and thereby exacerbate symptoms
We might unintentionally cause harm by following practices, policies and activities that are insensitive to the needs of our patients
Understanding trauma also means recognizing that our personal traumatic experiences or the stress associated with working in healthcare may impact our emotional and physical well being as well as our work success and satisfaction
TIC pilot
Aimed to understand whether TIC education can lead to practice change
Decision to pilot TIC training with one rural and two metropolitan EDs
Due to competing training priorities we offered multiple delivery options
Need for interdisciplinary training/collaborative approach inclusive of Lived experience
TIC pilot development
Co-design
Co-delivery
Content established initially for MHS then contextualised for the ED workforce
3 services invited to participate as a pilot site
Rural & 1 metropolitan pilot site planned as an 8 hour workshop (8 modules over 1 event)
1 metropolitan pilot planned over 4 days (45 minute modules delivered during in-service times)
Evaluation questionnaires developed to measure effectiveness of pilot
Focus groups scheduled 3 months post training
Modules
1. Introduction to Trauma Informed Care
2. Neurobiology
3. Social consequences of trauma
4. Cognitive model of trauma
5. Self fulfilling prophecy
6. Responding to stories
7. Trauma and the workforce
8. Where to from here
Participants
Trials completed:
52 Metropolitan attendees
17 Rural attendees
Total: 69
Participants demographics:
All Emergency Department nurses
Average age group: 25-30
Average years of experience in an ED: 5-10
Initial pilot outcomes
Allowing nurses to talk about trauma in an informed way
Nurses identified this education as one way to understand and prevent occupational violence
Beneficial to the mental well being of staff
Consumer project officer identified as one of the most valuable components of the day
Data reflected 100% of attendees would recommend this training to their colleagues & offered to other acute care staff
Module 7- ‘trauma and the workforce’ identified as one of the favourite modules
Outcomes 3 months post training
Participants reported:
Increased confidence engaging with persons with a trauma history
Desire for more education involving consumer consultants
Increased capacity to build more therapeutic relationships with patients
Circumstances where restrictive interventions have been avoided using skills learned during this training
Desire for permanent and accessible TIC education within their workplace
Key learnings
TIC education can lead to practice change
Restrictive interventions can be avoiding without adverse consequences
Nurses want more education on mental health presentations to the ED
Where to from here?
Further modules are being developed
Vicarious trauma
Child and infant trauma
Long term consequences of unaddressed trauma
Systems
Western Victorian Mental Health Learning & Development Cluster taking requests from services to have access to this education
Thank you