• Accelerated resolution therapy: an innovative mental health intervention to treat post traumatic stress disorder

      Finnegan, Alan; Kip, Kevin; Hernandez, Diego; McGhee, Stephen; Rosenweiz, Laney; Hynes, Celia; Thomas, Mike; University of Chester (British Medical Journal, 2015-07-03)
      Post-traumatic stress disorder (PTSD) is a disabling trauma and stress-related disorder that may occur after a person experiences a traumatic event, and evokes a combination of intrusion and avoidance symptoms, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Accelerated resolution therapy (ART) is an emerging psychotherapy that provides fast and lasting resolution for mental health problems such as PTSD. ART has been shown to achieve a positive result in one to five sessions, typically over a 2-week period, and requires no homework, skills practice or repeated exposure to targeted events. Initial research, including one randomised control trial, has demonstrated that ART interventions can significantly reduce symptoms of psychological trauma in both civilians and US service members and veterans. These results suggest that ART be considered as either a primary treatment option or for refractory PTSD in those with a suboptimal response to endorsed first-line therapies. Conservative estimates indicate substantial potential cost savings in PTSD treatment. Despite the need for more definitive clinical trials, there is increasing interest in ART in the USA, including in the US Army. The growing positive empirical evidence is compelling, and there appears to be sufficient evidence to warrant UK researchers undertaking ART research. The armed forces offer the potential for comparative international trials. However, equally important are veterans, emergency services personnel and those subjected to violence. ART appears to also have application in other conditions, including depression, anxiety disorders, and alcohol or drug misuse. ART can potentially help personnel traumatised by the unique challenges of war and conflict zones by providing brief psychotherapy in a readily accessible and culturally competent manner. ART facilitates the provision of interventions and resolutions in theatre, thus enhancing forces’ fighting capability.
    • Accountability

      Thomas, Mike; University of Chester (Sage, 2008-03-17)
      This chapter considers the concept of accountability within the nursing profession. It examines how the issue of accountability is no longer placed solely on the line manager and argues that the professional nurse or midwife is accountable for their actions at all times.
    • Anxiety and Compulsion Patterns in the Maintenance of Bingeing/Purging

      Thomas, Mike; Lovell, Andy; University of Central Lancashire; University of Chester (Wiley, 2014-09-12)
      This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n=12) of individuals diagnosed with Bulimia Nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an out-patient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety-containment and compulsion-maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns.
    • Characteristics and Values of a British Military Nurse. International Implications of War Zone Qualitative Research

      Finnegan, Alan; Finnegan, Sara; McKenna, Hugh; McGhee, Stephen; Ricketts, Lynda; McCourt, Kath; Warren, Jeremy J.; Thomas, Mike; University of Chester; Heath Lane Medical Practice; University of Ulster; University of South Florida; British Army; University of Northumbria; University of Chester; UCLan (Elsevier, 2015-08-01)
      Background. Between 2001 and 2014, British military nurses served in Afghanistan caring for both Service personnel and local nationals of all ages. However, there have been few research studies assessing the effectiveness of the military nurses’ operational role and no papers naming the core values and characteristics. This paper is the only qualitative nursing study completed in this period where data was collected in the War Zone. Objective. To explore the characteristics and values that are intrinsic to military nurses in undertaking their operational role. Design. A Constructivist Grounded Theory was utilised. The first author designed the interview schedule, then following a pilot study, conducted and transcribed the discussions. Informed consent and UK Ministry of Defence Research Ethical Committee approval was obtained. Setting. Camp Bastion Hospital, Afghanistan, in 2013. Method. Semi-structured interviews were conducted with 18 British Armed Forces nurses. Results. A theoretical model was developed that identifies the intrinsic characteristics and values required to be a military nurse. Nursing care delivered within the operational environment was perceived as outstanding. Nurses consciously detached themselves from any legal processes and treated each casualty as a vulnerable patient, resulting in care, compassion and dignity being provided for all patients, irrespective of their background, beliefs or affiliations. Conclusion. The study findings provides military nurses with a framework for a realistic personal development plan that will allow them to build upon their strengths as well as to identify and ameliorate potential areas of weakness. Placing nurses first, with a model that focusses on the requirements of a good nurse has the potential to lead to better patient care, and improve the quality of the tour for defence nurses. These findings have international implications and have the potential for transferability to any level of military or civilian nursing practice.
    • Cognitive learning theories

      Thomas, Mike; University of Chester (SAGE, 2010-10-29)
      This book chapter discusses theories of cognitive learning and how they apply to healthcare education and healthcare practices.
    • Effective Support for Serving Personnel

      Finnegan, Alan; Thomas, Mike (Adjacent Government, 2014-05-23)
      The British Armed Forces aim to provide a capable workforce, able to undertake military duties without mental health (MH) problems. This is achieved by maximising the psychological support afforded to soldiers by providing immediate and effective MH care wherever they are serving. The most common MH disorders affecting UK Armed Forces are depression, alcohol misuse and anxiety. Military Mental Health (MMH) provides an occupational MH service that makes recommendations regarding a service person’s suitability for service. In a peacetime setting, this is delivered through a clearly defined integrated care pathway between Primary Health Care, military Departments of Community Mental Health (DCMHs) and Secondary Health Care. DCMHs consist of multi-disciplinary clinical staff, providing service personnel with a medium for sharing problems, whilst utilising recognised treatments such as Cognitive Behavioural Therapy (CBT) including Eye Movement Desensitisation and Reprocessing. Hospital care is provided within the NHS through a defined contract. Performance indicators and military satisfaction surveys indicate that the British Armed Forces MH service is of a very high standard
    • Factors affecting mental health support to the British Armed Forces: Part One

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; University of Chester (Ptm Publishers Limited, 2014-11)
      To help the British armed forces minimise mental health problems while undertaking military duties, operational psychological support is provided by military mental health nurses. This series of two articles is part of the first qualitative research completed in Afghanistan by British armed forces into the effectiveness of the military mental health nursing role. The authors aim to increase understanding of the factors that affect the delivery of nursing care during an operational deployment, including educational and clinical competency, multiprofessional and multinational boundaries, and the challenges of providing nursing care for both military personnel and local nationals. This article, the first of the two-part series, looks at the set up of the study, while the second article (featured in the next issue of JCN) will look at the study findings
    • Factors affecting mental health support to the British armed forces: part two

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; University of Chester (Ptm Publishers Limited, 2015-01)
      The first part of this series (JCN, 28(5): 30–32) provided the background to the study, which used semi-structured interviews with 18 nurses based in Afghanistan during 2013 to focus on factors affecting the delivery of mental health care in the field. This, the second part of the series, details the results of the study in the form of analysis of the interviewees’ verbatim transcripts. The study offers an insight into the role of deployed mental health nurses and examines some of the challenges they face. The findings demonstrate that managing the mental health of armed forces personnel on an operational deployment requires the ability to develop trusting relationships, identify factors leading to stress, and help staff to feel supported.
    • Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan Study.

      Finnegan, Alan; Finnegan, Sara; Bates, David; Ritsperis, Debra; McCourt, Kath; Thomas, Mike; University of Chester (Elsevier, 2015-01-05)
      Background: This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. Aim: To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. Theory & methods: A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. Results: Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. Discussion: Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategywas viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patientswith similar injury patterns to thosewitnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should bemade of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised to provide education, mentorship, supervision and continuing personal development in the operational arena. The paper considers post-Afghanistan future options.
    • The presentation of depression in the British Army

      Finnegan, Alan; Finnegan, Sara; Thomas, Mike; Deahl, Martin; Simpson, Robin; Ashford, Robert; University of Chester (Elsevier, 2013-03-26)
      Background The British Army is predominately composed of young men, often from disadvantaged backgrounds, in which Depression is a common mental health disorder. Objectives To construct a predictive model detailing the presentation of depression in the army that could be utilised as an educational and clinical guideline for Army clinical personnel. Method and Participants Utilising a Constructivist Grounded Theory, phase 1 consisted of 19 interviews with experienced Army mental health clinicians. Phase 2 was a validation exercise conducted with 3 general practitioners. Results Depression in the Army correlates poorly with civilian definitions, and has a unique interpretation. Conclusion Young soldiers presented with symptoms not in the International Classification of Disorders and older soldiers who feared being medically downgraded, sought help outside the Army Medical Services. Women found it easier to seek support, but many were inappropriately labelled as depressed. Implications include a need to address the poor understanding of military stressors; their relationships to depressive symptoms and raise higher awareness of gender imbalances with regard to access and treatment. The results have international implications for other Armed forces, and those employed in Young Men's Mental Health. The results are presented as a simple predictive model and aide memoire that can be utilised as an educational and clinical guideline. There is scope to adapt this model to international civilian healthcare practice
    • Public health and contemporary health issues

      Thomas, Mike; University of Chester (SAGE, 2008-11-20)
      This book chapter discusses contemporary public health issues.
    • Special observations in forensic psychiatric practice: Gender issues of the watchers and the watched

      Mason, Tom; Mason-Whitehead, Elizabeth; Thomas, Mike; Faculty of Health and Social Care, University of Chester (Blackwell, 2009-11-01)
      Special observations in psychiatric practice may create tensions for both the patient under surveillance and the staff undertaking the procedure. This study reports on special observations undertaken in forensic settings focusing specifically on the gender sensitive issues. The aim of the study was to investigate the specific gender issues relating to special observations in relation to those under the procedure and those engaged in observing. Three medium secure units in the UK formed the sampling frame, and the population studied was eight female and seven male clinical Registered nurses. Semi-structured interviews were conducted, audio tape recorded and transcribed for analysis. The analysis involved a Grounded Theory approach to explicate categories and formulte two overarching themes: (1) the psychosocial fusion; and (2) the private as spectacle. There are implications for practice in relation to policy formulation and the implementation of special observations following risk assessment and individual skill identification. It is concluded that gender issues are extremely important for all concerned in this intrusive practice.