title: Mixed methods evaluation research for a mental health screening and referral clinical pathway.
abstract: BACKGROUND
  This study is an exemplar of mixed method evaluation research for development of a clinical pathway.
  
  
  OBJECTIVE
  To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans' Affairs-funded community nursing care of war veterans and war widows in the Australian context.
  
  
  METHODS
  Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team.
  
  
  RESULTS
  The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines.
  
  
  CONCLUSIONS
  The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors.
  
  
  CONCLUSIONS
  This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate practical, evidence-based clinical pathways.
authors.affiliation: School of Nursing, Deakin University, Burwood, Victoria, Australia. jacqui.allen@deakin.edu.au
authors.forename: Jacqui
authors.initials: J
authors.lastname: Allen
authors.forename: Merilyn
authors.initials: M
authors.lastname: Annells
authors.forename: Eileen
authors.initials: E
authors.lastname: Clark
authors.forename: Lyn
authors.initials: L
authors.lastname: Lang
authors.forename: Russell
authors.initials: R
authors.lastname: Nunn
authors.forename: Eileen
authors.initials: E
authors.lastname: Petrie
authors.forename: Alan
authors.initials: A
authors.lastname: Robins
mesh_terms: D001315:Australia; D003152:Community Health Nursing / Q000458:organization & administration*; D003299:Cooperative Behavior; D019091:Critical Pathways / Q000458:organization & administration*; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D011568:Psychiatric Nursing / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration; D019037:Urban Health Services / Q000458:organization & administration; D014728:Veterans