Carmelle Peisah

Purpose With training, non-professionals and carers working with older adults may opportunistically identify people at risk of suicide and refer for assessment and care. The study aims were to develop and test a bespoke e-learning suicide prevention tool utilising vignettes of typical gatekeeper interactions with older adults. Methods A previously published Australian e-learning tool regarding suicide prevention in older adults was adapted for New Zealand gatekeepers in consultation with cultural advisors and older people with lived experience of suicide. The tool comprised 14 questions including eight culturally-diverse scenarios of gatekeeper interactions with older adults at risk of suicidal behaviours. Learning was facilitated and assessed through pre/post-test and a middle lesson, with feedback sought. The tool was tested in New Zealand gatekeepers. Individual question and summed pre/post-test scores were assessed for change using Wilcoxon signed-rank test. Qualitative feedback regarding tool use was analysed. Results Of 77 participants starting the tool, 66 completed it. Majority of learners were tertiary educated women, in paid employment, with health professional backgrounds. Significant improvement in knowledge post-test was demonstrated in performance on all scenarios and total scores (pre:20.5/28- post:24.3/28; p < 0.001). Themes from qualitative analysis included perspectives on benefits, usability and acceptability of the tool, issues with content and reflection on gatekeeper roles. Conclusion A bespoke, collaboratively-developed and culturally-specific e-learning tool for New Zealand gatekeepers on identification and action regarding suicide risk in older people was developed. Knowledge translation and acceptability were demonstrated. Learning and culturally adaptative features may be readily applied to other international contexts.

Background In increasingly complex and stressed health environments, medical practice requires more from doctors than just knowledge and skills. Much has been written of wisdom, although there is a striking absence of reflection on its potential occupational application, particularly in medicine. This study aimed to adapt the wisdom construct to the medical professional setting and develop a new scale, the Medical Wisdom Scale (MD-WISE). Method We developed a prototype questionnaire based on domains and items from an existing validated tool—the San Diego Wisdom Scale (SD-WISE) (Thomas et al., 2019)—and a Delphi-style consensus process with a diverse range of selected subject matter experts, yielding a 56-item prototype scale. These candidate items mapped to nine putative domains of medical wisdom. The scale was tested on two independent samples of doctors recruited from a large urban health district in Sydney, Australia: Sample 1 completed the 56-item prototype for initial item screening; Sample 2 completed a reduced item set alongside the Authentic Leadership Self Assessment Questionnaire (ALSAQ) as part of assessing construct validity. Results Despite extensive recruitment strategies, Sample 1 data (n=64) precluded explorative factor analysis (EFA) and items were screened using alternative validated qualitative and quantitative approaches to generate a 20-item scale. From the 20-item version tested in Sample 2 (n=174), EFA supported a four-factor structure. Iterative refinement yielded a final 13-item scale (MD-WISE-13) comprising four factors: (i) Clinical Composure, (ii) Insightful and Reflective Practice, (iii) Self and Family Care, (iv) Respect for Patient Autonomy. The 13-item model demonstrated good fit in CFA (χ² = 66.42, p = .003; CFI = .965; TLI = .950; RMSEA = .066). Furthermore, the final MD-WISE scale demonstrated convergent validity with ALSAQ total scores (Pearson’s coefficient r =0.53, p <0.001, 95% Confidence Interval: 0.414-0.630). Conclusions We developed a pragmatic Medical Wisdom scale (MD-WISE-13) with a stable four-factor structure and evidence of good construct validity, measuring items that resonate with contemporary medical practice, with potential use for professional development.

Background/Objectives: The prevalence of mental health issues, such as depression, loneliness, and a decreased quality of life among older adults in long-term care (LTC) facilities in Thailand, calls for further study. In Thailand, where Buddhism is the predominant religion, many positive psychological strengths are fostered among older adults. One notable strength is equanimity, which is characterized by a balanced and accepting response to both positive and negative events. This practice is commonly associated with enhancing the well-being of older individuals. However, the study between equanimity and well-being is scarce. The purpose of the study is to assess equanimity in LTC residents and to determine if it is a significant predictor of the mental well-being of the residents. Methods: The cross-sectional data was obtained from 236 LTC residents in Thailand. Equanimity was measured using the Inner Strength-Based Inventory (iSBI) and mental well-being from the Thai Geriatric Depression Scale (TGDS-6). Demographic factors, depression, loneliness, and other inner strengths were also explored as covariates in a logistic-regression analysis. Results: The mean scores for equanimity (Mean = 3.78 ± 1.00) and mental well-being (Mean = 0.720 ± 0.449) were determined. The multiple regression analysis found equanimity significantly predicted well-being (B = 0.593, p = 0.002) along with depression (B = −0.395, p < 0.001) and mindfulness (B = 0.355, p = 0.046). Conclusions: This study identifies equanimity as a key predictor of mental well-being among Thai long-term care residents, alongside depression and mindfulness. While the study’s cross-sectional design limits causal conclusions, the results suggest that incorporating equanimity-based practices into geriatric care could be beneficial. Future longitudinal research is needed to validate these findings and improve resilience and well-being in aging populations.

Purpose: To examine the attitudes, experiences, and perceived facilitators and barriers to Advance Care Planning (ACP), of older people with schizophrenia and other psychotic illness and their carers. Methods: Older people with a psychotic illness and carers were recruited from public mental health services in Sydney, Australia. Semi-structured interviews to explore attitudes, experiences, and perceived barriers and facilitators to ACP were conducted by an external clinician. Consumers’ medical, psychiatric and drug health diagnoses were recorded and they completed cognitive and symptom rating scales. Reflexive thematic analysis was used to analyse the transcripts of interviews, within an interpretive description framework. Results: Thematic saturation was achieved with 12 consumers and 5 carers. Emergent themes from consumer interviews were (i) ‘What is ACP?’; (ii) ‘I have not done ACP because…..’; (iii) ‘I want to do ACP’; (iv) ‘If I was to do ACP I would need..’; and (v) ‘Mental health clinicians have the skills to help me with ACP’. Carer themes included (i) ‘We do not participate in ACP’, (ii) ‘I want to participate in ACP’, and (iii) ‘Key clinician skills are needed’. There was convergence of themes from both groups. Conclusion: This study demonstrates that older people with a psychotic illness can express views regarding ACP, despite ongoing symptoms of psychosis, cognitive impairment and mild–moderate severity of illness. The emergent themes highlight opportunities to intervene to overcome barriers to ACP, including education for both participant groups and clinicians, practical considerations and the need for all to collaborate, including with primary care.

Background and Objectives: Loneliness is prevalent among residents of long-term care settings, posing significant challenges to their mental wellbeing. Insecure attachment has been identified as a contributing factor to loneliness in this population. Previous research has suggested that meditation may have beneficial effects on mental health outcomes. This study aimed to examine the relationship between meditation, insecure attachment, and loneliness among residents of long-term care facilities in Thailand. Specifically, the study sought to investigate the moderating effect of meditation on the association between insecure attachment (both avoidance and anxiety) and loneliness. Materials and Methods: A cross-sectional study was conducted involving 236 residents living in long-term care homes in Thailand. Participants completed self-report measures including the 18-item Revised Experience of Close Relationship questionnaire (to assess attachment anxiety and avoidance), the Inner Strength-Based Inventory (to measure meditation practice), and the 6-item Revised Version of the University of California Los Angeles Loneliness Scale. Moderation analyses were performed to explore the role of meditation in the relationship between insecure attachment and loneliness. Results: The mean age of participants was 73.52 years, with females accounting for 57.6% of the sample. Among the participants, 58.4% reported engaging in meditation, with practice frequency ranging from often to daily. The mean meditation score was 2.92 out of 5, indicating regular but not daily practice. Meditation was found to moderate the relationship between insecure attachment (both avoidance and anxiety) and loneliness. Specifically, the moderation effect between attachment anxiety and loneliness was significant (B = 0.44, SE = 0.21, 95% CI [0.30, 0.86]), as was the interaction effect between attachment anxiety and loneliness (B = −0.34, SE = 0.17, 95% CI [−0.67, −0.02]). Conclusions: The findings suggest that the impact of meditation practice on loneliness is influenced by an individual’s attachment dimension. Meditation demonstrates a moderating effect on attachment avoidance, anxiety, and loneliness, with variations observed in the direction of these effects. The clinical implications of these findings and recommendations for further research are discussed.

Objectives: The objective of this systematic review was to synthesise literature pertaining to patient and family violence (PFV) directed at Intensive Care Unit (ICU) staff. Design: Study design was a systematic review. The data was not amenable to meta-analysis. Data Sources and Review Methods: Electronic searches of databases were conducted to identify studies between 1 January 2000 and 6 March 2023, limited to literature in English only. Published empirical peer-reviewed literature of any design (qualitative or quantitative) were included. Studies which only described workplace violence outside of ICU, systematic reviews, commentaries, editorials, letters, non-English literature and grey literature were excluded. All studies were appraised for quality and risk of bias using validated tools. Results: Eighteen studies were identified: 13 quantitative; 2 qualitative and 3 mixed methodology. Themes included: (i) what is abuse and what do I do about it? (ii) who is at risk? (iii) it is common, but how common? (iv) workplace factors; (v) impact on patient care; (vi) effect on staff; (vii)the importance of the institutional response; and (viii) current or suggested solutions. Conclusions: This systematic review demonstrated that PFV in the ICU is neither well-understood nor well-managed due to multiple factors including non-standardised definition of abuse, normalisation, inadequate organisational support and general lack of education of staff and public. This will guide in future research and policy decision making.

Objectives: This study aims to explore the feasibility and impact of Schwartz Rounds® led by psychiatrists/mental health professionals in an urban Australian public hospital setting and to develop strategies for optimising participants’ experiences. Methods: Being a mixed-methods study collecting qualitative and quantitative data through post-Rounds evaluation surveys, this study thematically analysed responses from 105 participants attending four consecutive monthly Rounds between February and May 2023 to assess the perceived benefits and challenges of Schwartz Rounds. Results: Respondents highly valued the Rounds and felt cared for by the healthcare organisation. Themes related to perceived benefits included (i) Connectedness and shared experience; (ii) Understanding other professionals; (iii) Normalisation of emotional distress, validation and a safe space for vulnerability; and (iv) Fostering authenticity and humanitarian aspects of healthcare. Challenges included (i) Fear of exposure and judgment; (ii) Emotional discomfort; (iii) Unfamiliarity with reflection; and (iv) Safety concerns. Conclusions: This study suggests acceptability and feasibility of implementing Schwartz Rounds within an Australian public health setting, particularly when facilitated by skilled mental health professionals. The outcomes provide preliminary support for the use of group interventions to enhance staff collegiality and culture in healthcare settings, thereby addressing critical needs for health professional wellbeing.