Nurse Specialists thought that a pamphlet which listed reputable websites would be a useful resource. The pamphlet was intended to be an adjunct to printed information already provided in the form of a business card with contact details for a community mental health service. The model of implementation is that the pamphlet would be discussed as part of the mental health assessment and websites thought to be especially relevant would be highlighted, for example those related to substance use for patients with substance use problems.
Development of an e resource forpeople who present to an emergency department with self-harm Michelle Honey School of Nursing, University of Auckland Lynne Weir Nurse Specialist, Liaison Psychiatry, Auckland City Hospital Sam Mason, Ryza Galsim & Serena Fisher Student nurses, School of Nursing,
Overview• Self-harm• The project• Process for evaluating websites• Identifying websites• Designing the pamphlet• Recommendations
Self-Harm• 2009 - 506 suicides; 2500+ self-harm related hospitalisations• 59.6 hospitalisations per 100,000 population (age-standardised)• Official estimates conservative;only included if admitted for 48hrs• Auckland Hospital most patients discharged within 24 hours• Men more suicides (3.6:1);Women more self-harm attempts (1.7:1)• 15-24 years highest intentional self-harm hospitalisation rate• 700+ hospitalisations in 2009.• Self-harm hospitalisation rates per 100,000 by ethnicity: – Maori 71.6 – Pacific peoples 28.3 – Other ethnicities 59.4
Context of Self-Harm• Person may present to a hospital ED• In Auckland ⇒ referral to Liaison Psychiatry• Specialty mental health team• Nurse Specialists undertake initial psychiatric assessment & risk assessment• Provide information and education• Refer patients to appropriate services that can be accessed after discharge.∗ person may be in a physical, mental and emotional state that makes it difficult to understand and remember information
The Project• A group of three undergraduate nursing students assigned to work with Liaison Psychiatry• Charged with creating a pamphlet outlining online resources for people seeking information about and support with mental health issues following self- harm.• The aims of this pamphlet: – reduce the rates of future self-harm – link patients with available online resources • By promoting web based interventions, people can access the support they choose at the times when they feel they need it most.
Process for Evaluating Websites• Need to identify legitimate and credible resources• Fitzpatrick & Montgomery 5 criteria: authority/source, purpose/objective, content, currency and design.• University of Illinois 10 criteria: accuracy, authority, currency, disclaimer, intended audience, links, purpose of the site, uniqueness, ease of use, and attractiveness.• Students selected 6 criteria: Authority/source, purpose/object, content, currency, design & what others say (alexa.com for history)
Identifying websites• Liaison Psychiatry recommended some• Used ‘Links’ section from these 150• Web searches with key terms = 150• Spilt into categories, analysed, chose best 59• In-depth analysis = 59 websites• Checked for appropriateness and relevancy for NZ = 24 24• Liaison Psychiatry confirmed 20 to use for pamphlet 20
Designing the pamphlet• A4 three-fold size – maximise information for a sheet of paper• Cost effective – can be printed as needed• White mostly with DHB colours• Images to increase visual appeal – green ribbon represents mental health awareness – orange ribbon represents self-harm awareness – mouse represents accessing www – hands symbolise reaching out for help • Websites grouped by subject & with
Strengths and Limitations• Strengths of the pamphlet include: – Provides people with additional information – In writing and individualised by team – Choice of web sites – Online help accessible 24/7 – Increased awareness of available services • Recommending websites allows people to access information at own pace when they are best able to process the information - ↑control & self-efficacy.• Limitations – currency of links, easy to lose
Recommendations• Best outcome is ↓ re-presentations to hospital• Short term - pamphlet is accepted for use in ADHB• Assess access to websites (alexa.com; pre & post)• Evaluate pamphlet after the first six months of use• Staff evaluate ease of use with patients• Assess patients’ interest in and receptiveness• Collect feedback from patients referred to community mental health services on whether pamphlet was used• Potential to add pamphlet to organisation’s website• If successful distribute to those at risk of self-harm