Research Output
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Publication
Enhancing GP care of mental health disorders post-Covid 19: A scoping review of interventions
2021-09-28, Keyes, B., McCombe, Geoff, Broughan, John, Frawley, Timothy, Guerandel, Allys, Cullen, Walter, et al.
An abundance of literature is being published reporting the negative mental health sequelae of the COVID-19 pandemic. This surge in mental health problems will likely present to primary care over the coming months. Initiatives are being proposed nationally and internationally to tackle this problem. It is of utmost importance for general practitioners to have interventions in place which can improve care of these mental illnesses. This research aims to undertake a scoping review of the literature to examine interventions which could be implemented in general practice post COVID-19 to improve care of mental health disorders arising from the pandemic.
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The impact of COVID-19 on health systems, mental health and the potential for nursing
2020-09-16, Frawley, Timothy, Fionn, Van Gelderen, Somanadhan, Suja, Coveney, Kate, Phelan, Amanda, Lynam-Loane, Paul, De Brún, Aoife
Coronovirus (COVID-19) has emerged as the first global pandemic in the twenty-first century (Anderson et al., 2020). COVID-19 is an infection from the new coronavirus Severe Acute Respiratory Syndrome CoVid-2 (SARS-CoV-2). Historically, coronaviruses only caused infections in animals. To date, we know of at least seven that have transferred to human beings. Most of these corona-related infections have caused mild symptoms. However, two, the Middle Eastern Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) have proved more severe and resulted in deaths (Ludwick & Zarbock, 2020). Political and health systems’ responses to COVID-19 have demanded extraordinary public health measures at a population level to respond to modifiable factors such as opportunity and transmission (Kucharski, 2020). Globally, the COVID-19 pandemic has imposed significant restrictions on social contact. In Ireland, a series of targeted social movement measures were implemented from March 27th, 2020. These included practices such as social distancing and cocooning for people over 70 years and those with various morbidities. Responses have also been focused on mass population based testing, isolation of those who are positive, contact tracing and social isolation of contacts. While the mental health impacts of this pandemic are not fully clarified, it is reasonable to project that there will be unintended, yet enduring impacts in the context of individual mental health, population health as well as impacts on the way health services are delivered in the medium term until a vaccine is isolated.
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Active learning in Mental Health Nursing - use of the Greek Chorus, dialogic knowing and dramatic methods in a university setting
2020-05-10, Donnelly, Peter, Frawley, Timothy
This article recounts a teaching method employed in a mental health module delivered in Ireland to international nursing students. In it the authors propose that there is a place for innovative teaching methods which combine active learning, dialogue, hard-fun and metacognition to stimulate student engagement and rich learning. We discuss an innovation ‘Movie-shoot’ which incorporated role-play with an analytical commentary by a Greek Chorus of nursing students. We argue this flexible teaching method enhanced active and rich learning, critical reflection and engagement and may be appropriate for use in nursing education.
Publication
How effective are General Nurses in recognising and preventing delirium in hospitalised patients?
2020-03-07, Somers, Karina, Frawley, Timothy
The literature indicates that delirium is a common problem among hospitalized patients in the acute hospital settings. The prevalence of delirium is reported to be 20-30% on medical wards within the acute setting (NICE, 2010). It is also reported by the HSE (2015) that it is being missed up to 67% of the time. METHODS: The study design was a descriptive cross-sectional survey of practicing nurses in the general ward setting, using an anonymized questionnaire. The questionnaire was divided into two sections, part A provided demographic characteristics and part B provided the level of knowledge the nurse will demonstrate on delirium. RESULTS: The questionnaire had a completion rate of 75% of the target population. Both electronic 30% and paper versions 70% of the questionnaire were used. Professional status was broken into three sections, Staff Nurse 62%, Nurse Specialist 17% and Nursing Management 21%. Years of experience was segregated into four sections, 0-5 years (9%), 6-10 years (10%), 11-20 years (43%) and finally 20 years or greater (38%). The participant’s level of knowledge on delirium was assessed by the 69 questions. The scores attained by the nurses from the knowledge questionnaire regarding delirium varied from 0 the lowest to 60 the highest, 41.31 +/- 12.883 being the average score. Scores were also viewed from professional status. Staff nurses (n=65) had a mean score of 41.25, +/- 13.552, Nurse Specialist Group (n=18) had a mean score of 42.83, +/- 12.803 and Nursing Management (n=22) had a mean score of 40.27, +/- 12.803. CONCLUSION: This under-recognition, along with increasing evidence regarding delirium treatment opinions emphasises the importance of a prompt accurate diagnosis. Improving delirium assessment to ensure early identification is critical for timely and effective management, yet delirium prevention, screening, recognition, and treatment are challenging for all levels of nurses.
Publication
A Rapid Realist Review of Group Psychological First Aid for Humanitarian Workers and Volunteers
2021-02-04, Corey, Julia, Vallières, Frédérique, Frawley, Timothy, De Brún, Aoife, Davidson, Sarah, Gilmore, Brynne
Humanitarian workers are at an elevated risk of occupational trauma exposure and its associated psychological consequences, and experience increased levels of anxiety, depression, and post-traumatic stress disorder (PTSD) compared to the general population. Psychological first aid (PFA) aims to prevent acute distress reactions from developing into long-term distress by instilling feelings of safety, calmness, self- and community efficacy, connectedness and hope. Group PFA (GPFA) delivers PFA in a group or team setting. This research sought to understand ‘What works, for whom, in what context, and why for group psychological first aid for humanitarian workers, including volunteers?’ A rapid realist review (RRR) was conducted. Initial theories were generated to answer the question and were subsequently refined based on 15 documents identified through a systematic search of databases and grey literature, in addition to the inputs from a core reference panel and two external experts in GPFA. The findings generated seven programme theories that addressed the research question and offered consideration for the implementation of GPFA for the humanitarian workforce across contexts and age groups. GPFA enables individuals to understand their natural reactions, develop adaptive coping strategies, and build social connections that promote a sense of belonging and security. The integrated design of GPFA ensures that individuals are linked to additional supports and have their basic needs addressed. While the evidence is sparce on GPFA, its ability to provide support to humanitarian workers is promising.
Publication
Interventions to Optimise Mental Health Outcomes During the COVID-19 Pandemic: A Scoping Review
2022-10, Safieh, Jacqueline, Broughan, John, McCombe, Geoff, McCarthy, Niamh, Frawley, Timothy, Guerandel, Allys, Lambert, John, Cullen, Walter
Adverse mental health has been a major consequence of the COVID-19 pandemic. This review examines interventions to enhance mental health outcomes and well-being of populations during COVID-19. Four electronic databases (MEDLINE, PsycINFO, Embase, and CINAHL) were searched following Arskey and O’Malley’s six-staged scoping review process. Twenty studies were included in the review. Various study populations were included to ensure greater generalisability of results. Interventions informing treatment of mental health concerns during COVID-19 were included and classified into (a) prevention of poor mental health, (b) therapeutic interventions, and (c) other interventions. Preventative strategies (n = 16) included public health education, modified social media use, technology-based interventions, physical activity, policy adaptations, and therapeutic interventions. Treatment strategies (n = 7) included adapting existing treatment and the creation new treatment programmes and platforms. While current evidence is promising, future research should focus on novel effective interventions to address mental health issues during the pandemic.
Publication
Higher Diploma in Mental Health Nursing
2019-10-17, Frawley, Timothy, O'Kelly, Gabrielle, Flanagan, Clare, Lonergan, Marie, Donnelly, Peter, Mac Neill, Deirdre, Maruthu, Rajinikanth, Conway, Rebecca
The Higher Diploma in Mental Health Nursing was launched in 2017 and is now entering its fourth year. On successful completion of this 53-week programme, participants are entitled to register with the NMBI in the psychiatric nurse division.
Publication
Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review
2017-06-29, Leahy-Warren, Patricia, Mulcahy, Helen, Benefield, Lazelle, Donohoe, Ann, Frawley, Timothy, Paul, Gillian, Phelan, Amanda, Stokes, Diarmuid, Walsh, Jessica, et al.
Background: Successful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings. The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature.
Methods: A scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google 'advanced' search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes.
Results: The evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies.
Conclusion: Use of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance.
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Evaluation of a national training programme to support engagement in mental health services: Learning enablers and learning gains
2019-11, Frawley, Timothy, Carroll, Lorraine, Casey, Mary, Davies, Carmel, Durning, Jonathan, Fealy, Gerard, Halligan, Philomena, Joye, Regina, Redmond, Catherine
INTRODUCTION: The Irish national mental health service provider commissioned a national training programme to support a patient and public involvement (PPI) initiative in mental health services. The programme evaluation afforded an opportunity to describe the learning gains and learning enablers and the factors that support PPI in mental health.
AIM: We aimed to evaluate a PPI training programme across nine regional administrative units in a national mental health service.
METHODS: We conducted a participant exit survey, using the Student Assessment of Learning Gains (SALG) instrument. We analysed the survey responses using SPSS version 24 software and applied directed content analysis to the narrative comments provided in open-ended questions.
RESULTS: A total of 54 participants returned the completed questionnaire, yielding a response rate of 60 per cent. The overall mean SALG score yielded was 3.97 (SD 0.66; range 1-5), indicating that participants reported very good to excellent gains in their learning from the programme. Participants who offered narrative comments indicated an overall positive experience but suggested that all stakeholders should work together to co-produce the training.
DISCUSSION: All the stakeholders in a PPI training initiative to support the engagement of service users, their families and carers in mental health, should work together to achieve their desired outcome. This requires co-production in the design, delivery and evaluation of the training initiative, and co-production can impact at both individual and local levels.
IMPLICATIONS FOR PRACTICE: PPI training initiatives in mental health should retain a focus on understanding conflict resolution, committee effectiveness, interpersonal and facilitation skills. Ensuring a shared understanding of key concepts, such as co-production, is a necessary prerequisite at the co-commissioning, co-design, co-planning, co-delivery and co-assessment stages of programme development As is the need to avoid artificial or actual distinctions between health professionals and those who are non-professionals, such as the service users.
Publication
Impact of organisational change for leaders in mental health
2018-10-31, Frawley, Timothy, Meehan, Annabel, De Brún, Aoife
Purpose – The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.
Design/methodology/approach – Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework.
Findings – Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda.
Research limitations/implications – Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.
Practical implications – There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.
Originality/value – The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.