From problem to potential solution: the development and implementation of the physical health nurse consultant roleBRENDA HAPPELLHAPPELL CONSULTINGUNIVERSITY OF NEWCASTLE

Physical health

• People diagnosed with mental illness experience decreased life expectancy (estimated 12-30 years)

• Largely due to preventable physical health conditions (78%) compared to suicide (14%)

u Medication side effectsu Socioeconomic factorsu Lifestyle (e.g. smoking, physical activity, diet)u Access u Stigma (attitudes of health professionals)

Influencing factors

Nurses

u Focus groups with nurses employed in mental health settings (n=38)

u Interview guide sought nurses’ views about physical health issues, how well they were addressed and potential barriers

Findings

u Acknowledge importanceu Acknowledge not well addressed, due to:

uLack of timeuLack of skilluLack of knowledgeuNot my job, focus on core business (mental health)

u Specialist physical health nurse position considered a potential strategy to address barriers

Findings

• Physical health care nurse specialist as potential solution• Supported by subsequent research:

• Pilot study conducted in Central Queensland showed improved health outcomes, and support for position (Happell et al. 2015)

• Physical health nurse in Vic increased metabolic screening rates from 3% (usual care) to 86% (McKenna et al. 2014)

Survey of Nurses in Mental Health

u National survey of members of ACMHN (n=643): uConfirmed main focus group findings uSupport for specialist nursing position (with

reservations)

Consumer perspectives

• Under-represented in the literature• Frequent assumption consumers don’t care

about physical health• Survey conducted by ACT Mental Health

Consumer Network found physical health ranked at number 3 of major concerns

Consumer perspectives project

u Focus groups x 4 (n=31)u One nurse, one consumer facilitatoru Approximately 7.5 hours total recordingu Range 80 – 160 minutesu Thematic data analysis led by consumer

researcher

Findings

u Participants described frequent neglect of physical health, themes included:uDiagnostic overshadowingu Ignored u Talking at, not withu Financial limitations

u Specialist nursing role considered a potential solution (with some caution)

Carer perspectives

u Role of carers in supporting people with mental illness has been identified

u Limited research into carers views about physical health issues suggests:

ulimited access to GPS and primary health uHealth professionals discounting physical

health problems

Carer perspectives project

u Qualitative exploratory studyu Support and assistance from Carers ACTu Two focus groups and one individual interviewu 13 participantsu Interviews conducted by nurse and carer

interviewer

Findings

uTwo main themes:uLack of service access and responsivenessuShortage of care coordination

uPhysical Health Nurse Consultant role viewed very positively, particularly for improved coordination

Trial of specialist nursing position

u Six month pilot studyu Specialist nursing position compared to

treatment as usual

Findings – Intervention Group

u Increase in consumers meeting physical activity guidelines

u Modest increase in fruit and vegetable intakeu Reduction in smokingu Insufficient numbers for statistical significance,

however demonstrated potential for the roleu Lessons learned from the implementation

process to underpin larger study

Nurses’ attitudes

uPre/post intervention views of nurses perceptions of specialist nursing role

uPaper-based survey u Initial n = 42, follow up n = 22uSupport for the role was evident initially

and increased following the studyuAmbivalence about the role also

reduced

Discussion and conclusions

u Support for specialist role evident from nurses, consumers and carers

u Role may contribute to:u Improved coordination of careu Integrated physical and mental health careu Improved physical health care (most important)

u Need for further research to explore potential of the role

Contribution of research findings

u Lots and lots of grant applications, sadly unsuccessful with some near misses

u Finally, success!!!! National Health and Medical Research Council Grant: u Improving the cardiometabolic health of people with

psychosis: The Physical Health Nurse Consultant service

u A combination of factors including a solid research background for intervention and persistence +++++

Research Team

u Me, MHN academic

u Dr Jackie Curtis – Psychiatrist, leader of the Healthy Active Lives declaration

u Dr Michelle Banfield – Consumer researcheru Mr John Goss – Health Economistu Dr Theo Niyonsenga – Statisticianu Dr Rob Stanton – Exercise Physiologist, Researcheru Mr Andrew Watkins – MHN clinician and researcheru Dr Chris Platania-Phung – Mental Health Researcher (Psychology

researcher)u Ms Julia Bocking – consumer researcheru Dr Lynelle Moon – Epidemiologist u Dr Phil Batterham – Statistician

Brief Overview

u 24 month Randomised Controlled Trial comparing treatment as usual to treatment as usual plus PHNC

Outcome measures

u Burden of Disease risk factors: BMI (primary outcome measure), total cholesterol, fasting glucose, systolic blood pressure, smoking, fruit intake, vegetable intake, daily alcohol intake, binge drinking, physical inactivity;

u Consumer experience of care: experience, acceptability, shared decision making, quality of life;

u Cost-effectiveness of physical health service delivery.

Conclusions

u Exciting opportunity to implement an evidence-based strategy to improve physical health care for consumers of MH services

u Nurse-led initiativeu Comprehensive evaluationu Watch this space!

Brenda HappellBrenda.Happell@gmail.com