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Selected AbstractsSelf-advocacy in historical perspectiveBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 3 2006Ian Buchanan Accessible Summary ,This paper looks at the history of self advocacy in England. ,,Self advocacy has helped many people with learning difficulties to speak up and gain more confidence. ,,But now it is associated with Government policy. After Valuing People, people expect self advocacy organizations to speak up for everyone with learning difficulties. ,,This might mean there is less time and space to help new people learn about speaking up as individuals. ,,It is important to find ways to support self advocacy groups, especially those run by people themselves, to avoid this happening. [source] Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unitJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2010F. VAROL TAS md Accessible summary ,,The views of patients and their relatives regarding the treatment are extremely important in mental health as well as in other medical disciplines. ,,In our study, consistent with the literature, the satisfaction levels of young people and their families regarding the service they got during their stay in the unit were determined to be high. ,,The questionnaire used in the survey was designed to allow for five domain-based subscales which were admission process, staff, environment/services, treatment interventions and treatment outcome. ,,The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that; the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. ,,The results of such studies help to improve the quality of treatment and the mental health service that children and adolescents and their families receive. Abstract The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit. [source] Social comparison as a coping strategy among caregivers of eating disorder patientsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2010I. JÁUREGUI LOBERA md phd Accessible summary ,,The paper describes social comparisons among caregivers of eating disorder patients as a coping strategy. ,,Different social comparison strategies were assessed in a sample of 96 caregivers as well as their self-esteem, characteristics of personality and perceived quality of life. ,,The use of unfavourable strategies was correlated to neuroticism and low self-esteem. ,,Women adopted worse strategies and the fact that having obtained different subgroups regarding the use of those strategies could have prognostic repercussions. Abstract The aim of the study was to determine any gender differences in the social comparisons made by caregivers of eating disorder patients and to analyse the relationship between social comparison and personality, age of caregivers, self-esteem, duration of illness, duration of treatment and perceived health and quality of life. We also explored the possibility of classifying caregivers according to these variables. Comparison strategies were analysed in a sample of 96 caregivers of eating disorder patients. The social comparison during illness scale, visual analogue scales of health and quality of life, self-esteem scale of Rosenberg and Eysenck Personality Questionnaire were used. In order to explore possible groupings a cluster analysis was performed. A significant correlation between the use of more unfavourable strategies, neuroticism and low self-esteem was found. Women adopted worse strategies and the cluster analysis revealed two sub-groups with respect to comparisons, personality, self-esteem, self-perceived health status and quality of life. The finding of subgroups associated with worse comparison strategies, higher neuroticism, lower self-esteem and a poorer self-perception of health and quality of life could have repercussions as regards the prognosis of eating disorders and, at all events, should be taken into account during therapeutic work with families. [source] A phenomenological exploration of the lived experience of mental health nurses who care for clients with enduring mental health problems who are parentsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2010S. MADDOCKS mnurssci rn Accessible summary ,,Among people with mental health problems, those who are parents may not have their needs met, especially when receiving inpatient care. ,,There is little research regarding the needs of this group. ,,An integrated model of care is required. Abstract This paper is a report of a study to explore mental health nurses' lived experience of caring for adults with enduring mental health problems who are parents. With the advent of community care, more people with enduring mental health problems have contact with their families and are parents. Ultimately, rehabilitative strategies for parents with mental health problems are focused towards functioning effectively within their own family unit and hopefully enabling them to fulfil their parental role. Mental health nurses working with this client group have competing demands to reconcile. For example, advocating for client rights versus protecting the child and supporting the family. This phenomenological study took place within adult mental health services in the UK. Semi-structured interviews were conducted with six nurses. A thematic analysis was conducted on the data. Five themes were identified from the data: support, remaining impartial, addressing the specific needs of a client who is a parent, models of care and interagency communication. The findings suggest that neither a family-centred nor a person-centred approach to care completely meets the needs of this client group. An integrated model of care is proposed that applies person-centred and family-centred approaches in tandem. [source] An exploration of mental health nursing students' experiences and attitudes towards using cigarettes to change client's behaviourJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2010M. J. NASH msc pclt bsc (hons) rnt rmn fhea Accessible summary ,,This study explores the experiences of mental health nursing students in using cigarettes as a means of token economy. ,,The majority of the sample experienced the use of this particular intervention in various settings but also reported that other items apart from cigarettes were also used as part of a reward system. ,,Respondents generally did not like this practice, feeling that it did not work well, led to client staff conflict, was implemented in an ad hoc way and rarely recorded in a care plan. ,,An open debate on tobacco control and the use of cigarettes in behavioural change programmes is urgently required. Abstract Using cigarettes to change client behaviour is a common, yet little studied, practice in mental health care. A questionnaire survey was used to explore mental health nursing student's experiences and attitudes to this practice. The sample was four cohorts of mental health nursing students (n= 151). Of them, 84% had experienced the practice of using cigarettes to change client behaviour in acute wards (73%), rehabilitation wards (28%) and elderly care (14%). Cigarettes were used to change client behaviour in areas such as attending to personal hygiene (57%) or engaging in the ward routine (39%). However, items such as leave (60%) or drinks (tea and coffee) (38%) were also reportedly used. Of the respondents, 54% inferred that the practice did not work well with 46% stating it was not written up in care plans; 52% felt it was an ad hoc practice, 60% inferred that at times it was used as a punishment while 55% intimated that they felt bad withholding cigarettes. There are ethical and moral dilemmas around using lifestyle risk factors as rewards or using client's nicotine addiction as a means of controlling behaviour. The question of whether this intervention should ever be used, given its associated health risk, requires more critical debate in clinical practice. [source] Writing the reflexive self: an autoethnography of alcoholism and the impact of psychotherapy cultureJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 7 2010A. GRANT ba (hons) ma phd cert res meth pgctlhe, enb 650 cert Accessible summary ,,Experimental ethnography allows for the use of fiction in writing. Fiction both enables the preservation of anonymity in accounts based on real people and events and breaks down the barrier between art and science in ethnographic work. The use of fiction, which should not be regarded as synonymous with falsehood, arguably facilitates telling tales in a dramatic and enjoyable way. It is also a useful way of ,writing the self', so that the researcher and the researched become one and the same. Writing the self means using fiction and other literary tools to both construct and clarify the person being written about. In the case of autoethnography, this person is both the researcher and the researched. ,,The short story, which forms the heart of this paper, is based on the author's battle with alcoholism over two decades. It utilizes literary devices, including poetry, time changes, and moves from describing the main protagonist in the story in first to third person. The story describes the author's experiences of feeling increasingly stigmatized and treated as ,other' by members of the humanistic counselling and therapy fraternity. ,,The paper draws to an end with a theoretical discussion of the development of selfhood in society, including the ways in which alcoholic selves can become stigmatized and ,othered'. The author invites readers to contribute towards ending ,us,them' divisions. Abstract Experimental ethnography enables the use of fictionalized accounts that celebrate partial truths and challenge realist and positivist ethnographic authority. Literary devices drawn from fiction arguably allow social researchers to better portray real events. Fiction, which should not be regarded as synonymous with falsehood, enables the telling of tales in dramatic and enjoyable ways. In this account , an autoethnography of alcoholism and the impact of therapy culture , the author's intention is not to make claims for a final word or closure on the topics raised, and juxtaposed with appropriate social theory. It is rather hoped that the text will trigger further meaning creation on the part of the reader and, in terms of praxis, contribute towards creating a kinder and more humane mental health nursing and therapy practice and in the ,off duty' world. [source] Using systemic reflective practice to treat couples and families with alcohol problemsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 7 2010B. FLYNN rgn rmn dip cpn dip acc ma Accessible summary ,,Alcohol services in the UK generally treat clients from an individual medical and psychiatric perspective. Carers, partners, children and other family members are infrequently actively involved in the clients' care process. ,,A reflective family-based approach was introduced in an attempt to improve treatment engagement with drinkers with relatives. Favourable findings from several self-reporting research and evaluation studies are provided and analysed. ,,The use of this intervention was found to be effective in facilitating change in drinking and relationships. Family members when involved in the care management proved to be influential in the behaviour change process. ,,Family group reflecting interventions should be used more extensively and involvement of partners and family members in care programmes should be promoted. Implications for the extended use of the intervention both in addiction settings and wider health and social care practice are discussed. Abstract In the UK, an adult with a drinking problem is generally treated from an individual perspective with minimal involvement of carers and relatives. In response to this gap in service provision, a systemic reflecting intervention was introduced to assist couples and families experiencing alcohol-related difficulties. The article documents the background and development of this initiative. Findings from evaluation and clinical outcome studies are reviewed and demonstrate how the use of the approach proved to be effective in facilitating positive change both in drinking and family behaviour. In conclusion, the paper explores the implications of how systemic reflective practice with family groups may be extended and be usefully used in wider addiction, diverse mental and general health-care settings. [source] Nurse prescribing in mental health: national surveyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2010D. DOBEL-OBER phd Accessible summary ,,Nurse prescribing has grown relatively slowly in mental health care since it was introduced in early 2000s. ,,This paper reports findings from a survey of directors of nursing in England. ,,It provides information about the current level of development of nurse prescribing and about intentions with regards to future implementation and development. Abstract Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves. [source] Nurses , psychiatrists' main collaborators when treating women with postpartum psychosisJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2010I. ENGQVIST rn ms Accessible summary ,The paper describes Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). ,,A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. ,,This result was identified: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards. Decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was very important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams as outpatient clinic, child health clinic and community services, was required. ,,The conclusion was that psychiatrists collaborate with different professionals in the different parts of the caring process. When caring for women with PPP, they considered nurses to be their most important collaborators and relied on their competence. Abstract The focus was to describe Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses' competence when caring for women with PPP, and consider nurses to be their most important collaborators. [source] The Strengthening Families Program 10,14: influence on parent and youth problem-solving skillJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2010Y. SEMENIUK ms rn Accessible summary ,,Study reports the results of a preliminary examination of the efficacy of the Strengthening Families Program (SFP) 10,14 in improving parent and young adolescent problem-solving skill among 57 dyads using the Iowa Family Interaction Rating Scale (IFIRS) and Dyadic Assessment Intervention Model analysis methods. ,,None of the hypothesis was fully supported. Outcomes for parents were contrary to prediction. ,,Though SFP 10,14 demonstrated questionable efficacy for problem solving skill particularly among adults in this small sample with limited follow-up, parents and youth enjoyed the intervention. ,,Persons implementing family skill training programs may let participants know that youth tend to grasp the skills earlier and with less effort than adults. Abstract The aim of this paper is to report the results of a preliminary examination of the efficacy of the Strengthening Families Program (SFP) 10,14 in improving parent and youth problem-solving skill. The Hypotheses in this paper include: (1) youth and parents who participated in SFP would have lower mean scores immediately (T2) and 6 months (T3) post intervention on indicators of hostile and negative problem-solving strategies; (2) higher mean scores on positive problem-solving strategies; and (3) youth who participated in SFP would have higher mean scores at T2 and at T3 on indicators of individual problem solving and problem-solving efficacy than youth in the comparison group. The dyads were recruited from elementary schools that had been stratified for race and assigned randomly to intervention or comparison conditions. Mean age of youth was 11 years (SD = 1.04). Fifty-seven dyads (34-intervention & 23-control) were videotaped discussing a frequently occurring problem. The videotapes were analysed using the Iowa Family Interaction Rating Scale (IFIRS) and data were analysed using Dyadic Assessment Intervention Model. Most mean scores on the IFIRS did not change. One score changed as predicted: youth hostility decreased at T3. Two scores changed contrary to prediction: parent hostility increased T3 and parent positive problem solving decreased at T2. SFP demonstrated questionable efficacy for problem-solving skill in this study. [source] Could repressive coping be a mediating factor in the symptom profile of individuals diagnosed with schizophrenia?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2010B. SCHOLES rmn bn spq (mental health) msc pgctlhe Accessible summary ,,This paper considers the potential impact of identifying individual coping style on the concept of schizophrenia within the framework of the stress vulnerability model. There is discussion of the role of psychological theories in our understanding of schizophrenia and the experience of those who live with this condition. ,,The concept of individual coping style, with particular attention to repressive coping style, is considered and the research on the impact of coping style on the person's mental and physical well-being is discussed. Whether this way of thinking about and understanding repression is helpful in how we understand schizophrenia is then considered. ,,Possible implications of identifying repression in people with schizophrenia by using the idea of coping style as a measure of this concept are considered, gaining and understanding of what role this identification may have on our understanding of how people experience this condition and express this experience to those who work with them. ,,The potential for study in this area may allow a greater understanding of the way in which our protective psychological functions interact with experience of the distressing and challenging symptoms, often associated with schizophrenia, and influence future understanding of the process and progress of this condition. Abstract Despite a relatively high prevalence, and the enduring patronage of the disorder by psychiatry and the pharmaceutical industry, innovative conceptualization of schizophrenia in a client-empowering and quality of life-enhancing way appears to represent a vacuum within the clinical agenda, certainly taking second place to ,patient management'. However, against this bland background of medicalization of what is clearly a poorly understood and complex multifactorial syndrome, innovative treatment approaches aimed at symptom control, in particular, the stress vulnerability model (SVM), have been developed. However, the SVM is an incomplete model of patient experience and says little of aetiological note. One area of psychological function that may give further insight into the symptom experience associated with schizophrenia within the context of stress vulnerability concerns the mechanisms of repression. Ironically, the notion of repression will for many represent the epitome of non-evidence-based psychiatric theory and related psychodynamic therapy practice. However, more contemporary work within the psychological literature has aimed to make the concept both measurable and observable. No longer occluded by the context of psychoanalysis, cognitive science accounts of repression may be of value in facilitating understanding of the variability and predictability of symptoms of schizophrenia and may provide a dimension of therapeutic engagement allied to the SVM. [source] The sexual and relationship needs of people who experience psychosis: quantitative findings of a UK studyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2010E. MCCANN phd rmn msc dippi pgdip academic practice fhea Accessible summary ,,Distinct lack of studies exist that explore sexual and relationship issues. ,,Captures important experiences of people who use mental health services. ,,Reveals potential obstacles to the expression of sexuality. ,,Identifies a diversity of needs. ,,Presents issues that may guide mental health practice, education and research. Abstract Few studies have investigated the experiences of people regarding sexual and relationship issues in the area of mental health. This study presents the quantitative findings of a larger study that was conducted in London, UK. The aims of the study were to establish client's sexual and relationship experiences and perceived needs. A total of 30 people with a medical diagnosis of schizophrenia, living in the community, were interviewed using three questionnaires. The first related to demographics, the second used relevant parts of the Camberwell Assessment of Need (CAN) and the third looked at possible determinants of sexual behaviour. The CAN also captured keyworker responses to issues related to their clients sexual and relationship requirements. The results showed that 83% of the clients were currently experiencing sexual feelings. Some 90% of clients felt some need in relation to sexual expression and 83% for needs related to intimate relationships. Only 10% of staff recognized sexual expression as a need in clients in their care and 43% perceived a need for intimate relationships. Furthermore, most clients interviewed thought that their psychotropic medication caused sexual problems. Contrasts are made with other studies to help highlight the important issues that emerged for service users. [source] Relatives of persons with recently discovered serious mental illness: in need of support to become resource persons in treatment and recoveryJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2010K. NORDBY cand. polit. rpn Accessible summary ,,Relatives want the health workers to regard the patient not only as sick but also regard him/her as a person. Parents want to get involved at an early stage and find it important that their opinions and experiences are heard. The staff also express that relatives possess knowledge that should be important for them to receive. ,,The relatives underline the importance of an opening for hope to be present at all time, else you do not have the strength to cope with the situation. No matter how pessimistic the staff are, hope must be expressed. ,,The relatives want to know what happens after discharge. They do not always know what questions to ask before discharge as challenges are discovered gradually. They want to know how to behave and what to say to their family member with a psychiatric illness. When parents can impart their concerns and receive adjusted counselling their level of stress is reduced. ,,It is important to consider relatives as resource persons. The staff consider themselves as experts on psychosis and the parents as experts on their own children. Abstract A considerable amount of research on the treatment of young people suffering from serious mental illnesses states that good collaboration with relatives is essential for reducing relapse, improving recovery and enhancing quality of life for patients and relatives. The aim of this study was to explore and describe what facilitates active involvement for relatives in the treatment and rehabilitation of their family member. The present study is a part of a larger cooperative inquiry project carried out in a mental hospital in southern Norway focusing on improving practices for collaboration with relatives. This sub-study presents results from eight focus group interviews with relatives and staff members. Data were analysed by means of qualitative content analysis. The results showed that the relatives had mostly positive experiences from their encounters with the staff, although some negative experiences were articulated. Both relatives and staff underlined the importance of developing a good encounter characterized by sharing information, giving guidance and support according to the relatives' needs as well as addressing existential issues. This was perceived as a necessary basis for the relatives to become active participants in the treatment and rehabilitation process. To activate this basis, the relatives are dependent on the staff members' ability to convey and nurture hope related to the patient's recovery and quality of life. [source] Managing the risks of physical intervention: developing a more inclusive approachJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2010L. HOLLINS bsc physiotherapy Accessible summary ,,It is imperative that the use of physical interventions be reduced. However, when they are used the safety of recipients must be maximized. ,,A focus on the ,prone restraint position' has led to a narrowed understanding of the risks associated with the application of force during restraints. ,,The ,transitional stabilizing position' offers a platform upon which to consider the broader risks arising during restraints. ,,Training staff to manage such situational risks, using a variation on the existing ABC safety check could be instrumental in reducing the likelihood of adverse outcomes associated with restraints. Abstract Since psychiatry evolved as a professional discipline, mental healthcare professionals have had to, as a last resort, physically intervene to manage physically aggressive patients. In the United Kingdom, physical intervention techniques migrated from the prison service in the mid 1980s where there was extensive use of two particularly controversial practices; ,pain compliance' and the ,prone restraint position'. This paper examines how the classification of the ,prone restraint position' has led to a narrowed focus on one technique and a resultant misunderstanding around the wider risks associated with the applying force and managing restraints. The paper goes on to propose the ,transitional stabilizing position' (TSP) as an alternative concept and puts forward a dynamic risk assessment model. It explores how a shift in staff training away from developing pure competence in the performance of tightly specified techniques to managing the patient in TSPs could conceivably reduce the relatively low risk of death or serious injury associated with the application of restraint techniques to an even lower level. [source] Section 5(4) (The nurse's holding power): patterns of use in one mental health trust (1983,2006)JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2010R. ASHMORE bsc(hons) rmn ma pgce dip coun Accessible summary ,,Section 5(4) (Nurses' holding power) allows a mental health nurse to detain a patient admitted informally to hospital for treatment of a mental health problem for up to 6 h or until they are assessed by a doctor. ,,The use of the holding power has risen significantly since its introduction in 1983 to an average of 1442 per annum (range 789,1953 per annum). ,,The study identifies a number of factors in relation to the use of Section 5(4) including: gender, clinical setting, temporal patterns and medical response time. ,,Although the majority of patients are assessed by a doctor within 4 h of the holding power being applied, 8.3% are detained for 6 h or longer. There is a need to explore this and other issues further. Abstract The majority of studies exploring the use of Section 5(4) (Nurses' holding power) of the Mental Health Act 1983 are now dated, report on small numbers and have been undertaken over relatively short periods of time. A retrospective study was undertaken which sought to identify the factors associated with the use of the section in one mental health trust over a 24-year period (1983,2006). Section 5(4) was applied on 803 occasions, an average of 33.4 times per annum. The majority of sections were applied to female patients (58.4%) by male nurses (54.9%) within adult acute inpatient settings (93.4%). Significant differences were noted in the use of the section over the 24-h period but not for month of the year or day of the week. A total of 349 (43.5%) sections were implemented during doctors' ,office hours' (Monday,Friday, 9:00 h to 17:00 h). The mean length of time spent on the section was 140 min; 80.6% of patients were assessed by a doctor within 4 h; and 8.3% remained on the section for 6 h or more. The holding power was converted to another section of the Act on 642 (80%) occasions. A similar, multi-sited prospective study could be undertaken to validate the findings of this study. [source] Ethnography and the ethics of undertaking research in different mental healthcare settingsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2010H. ALLBUTT rgn ba msc phd Accessible summary ,,We report our experiences of seeking regulatory approval to undertake a qualitative research study using observation and interviews in three different mental healthcare settings. ,,All users of mental health services are classified as ,vulnerable' research participants by UK regulatory research systems. We argue that this is both disempowering to users and also at odds with current health care policy to promote service user involvement in research processes. ,,Access to mental healthcare sites was difficult in spite of agreement by senior area managers. Front-line team leaders acted as gatekeepers to influence which service users could be approached to take part in the study. This type of intervention may bias research samples and dilute the knowledge claims researchers can make from research undertaken in practice settings. Abstract This paper draws on our experiences of seeking research ethics and management approval for a 1-year ethnographic research study in three mental health settings. We argue that the increased bureaucratization of research governance in the UK is paternalistic and unfit for qualitative, non-interventionist study designs. The classification of all mental health services users as ,vulnerable' is also disempowering and contrary to government calls to increase user involvement in research processes. We relate our difficulties in accessing National Health Service sites to undertake our study despite endorsement by senior managers. The current research ethics system reinforces the gatekeeping role of front-line National Health Service staff but this may work to bias samples in favour of ,amenable' service users and exclude others from having their views and experiences represented in studies over the long-term. [source] Medicine use in older people's inpatient mental health servicesJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2010J. A. BAKER phd mphil msc bnurs (hons) rmn Accessible summary ,,Aging increases the risks associated with medicines. ,,Complex regimes of medicines are used with older people in mental health services. ,,Mental Health Nurses need to consider their skills and knowledge in dealing with these complex regimes. Abstract The aims of this audit were to establish the range and volumes of medicines used in older people's mental health settings and to explore the safety of the prescribing habits through the application of the revised Beers criteria. An audit of all patients on all selected wards (both functional and organic) for current prescriptions of all drugs routinely prescribed on the census day was undertaken on 11 wards in three Mental Health NHS Trusts in the North West of England. Data were collected on 154 patients in 11 different inpatient settings in three Mental Health Trusts. A total of 153 patients had 882 prescriptions of 196 drugs (mean 5.8 drugs). Most frequently prescribed drugs were aspirin (n= 57, 6.5%), paracetamol (n= 36, 4.1%) and quetiapine (n= 35, 4.0%). Nine of the 48 potentially inappropriate medicines in the revised Beers criteria had been prescribed, although at within appropriate limits. The audit highlights the complexity of poly-pharmacotherapy in older adults admitted to mental health services. Further works needs to establish whether nurses have the clinical knowledge and skills to ensure safe practice. There appears to be continued variation in prescribing practice. [source] A preliminary analysis of narratives on the impact of training in solution-focused therapy expressed by students having completed a 6-month training courseJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2010S. SMITH ba (hons) ba pgctlt rmn rnt fhea Accessible summary ,,Students who participated in a six month training course in SFBT reported significant changes in their relationships with clients. ,,They reported increased trust in clients as people, increased confidence in their own professional role, and increased enthusiasm for working with clients. ,,Students demonstrated an in-depth knowledge and understanding of solution focused principles and practice, enabling them to own their practice and respond creatively to individual clients. ,,It is suggested that substantive training in solution focused brief therapy may help to enhance the professional role and cultural identity of participants, particularly those from a nursing background. Abstract Solution-focused brief therapy (SFBT) is a therapeutic approach utilized in a wide variety of settings. Its roots are in systemic and family therapy, and the emphasis in practice is on helping clients identify what their life will be like when they no longer have their problem, and how close they are to experiencing that situation now. The literature suggests that SFBT is at least as effective as other forms of psychotherapy. This pilot-study explored the impact of a training course in SFBT on the nurses who took part. Interviews were carried out with participants (n= 8) and narrative accounts were analysed and grouped according to emerging themes. Three major themes were perceived; Trust in clients, Positivity and Confidence, and these were supported by interconnected minor themes relating to the eclectic use of the approach, the use of language within the approach, and the application of SFBT in wider life. It is argued that training in SFBT may have a positive impact on the therapeutic and professional role of nurses, and that further studies are required to explore the impact of SFBT training on the professional and cultural identity of nurses. [source] Autoethnographic ethics and rewriting the fragmented selfJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2010A. GRANT ba (hons) ma phd rmn pgctlhe cert res meth enb 650 cert Accessible summary ,,This paper juxtaposes my own mental health problems with autoethnographic ethics relevant to my subject matter. ,,Autoethnographic ethics are treated according to their historical development in the social sciences. ,,It is argued that culture flows through self and vice versa. Abstract The paper begins with a summary of severe mental health difficulties I had in recent years. The narrative then turns to the crisis of representation in the social sciences which gave rise to autoethnographic ethics. Autoethnographic writing is compared and contrasted with realist writing, the former being seen to be accorded with several advantages when ,writing the self'. It is argued that culture flows through self and vice versa, and that this is captured well in autoethnographic work. The various forms of ethics are brought to light in relation to my experiences of state acute mental health care. [source] The development of nurse-led suicide prevention training for multidisciplinary staff in a North Wales NHS TrustJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2010R. JONES rmn bsc msc Accessible summary ,,Suicide and suicidal behaviour evoke strong feelings. That is so not only for those directly affected , the individual, family and friends, but for professional staff and the community at large. ,,Assessing the risk of suicide demands staff having the ability to connect and maintain rapport with people in varying degrees of distress. ,,Multidisciplinary training groups allow staff the opportunity to share their experiences and learn from one another. ,,Suicide awareness training for non mental health staff in the UK is variable and should be more of a priority. Abstract There are 300 deaths in Wales each year as a result of suicide. Though the rate in England and Wales has fallen in recent years, it is still the second most common cause of death in men aged 15,44 behind accidental death. The majority of those who die by suicide make contact with health professionals within a relatively short time before their death. For those with mental ill health, relationships with professionals appear particularly important; indeed negative relationships have been cited as a key factor precipitating death by suicide. This paper outlines a suicide awareness programme which aims to restate the values of empathy and relationship building in everyday interaction. It acknowledges risk factors and risk assessment tools, but more than anything strives to demonstrate the value of encouraging personal expression in patients. [source] Uncovering sexual abuse: evaluation of the effectiveness of The Victims of Violence and Abuse Prevention ProgrammeJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2010J. DONOHOE bsc Accessible summary ,,Discusses factors inhibiting open talk around a client's history of abuse including gender, age and diagnosis. ,,Evaluates the helpfulness of a training course designed to reduce and overcome these factors. ,,Aim of the evaluation is to help replicate the training nationally, following the positive impact found. Abstract Despite the high prevalence of sexual abuse among users of mental health services, it appears that mental health professionals are frequently unaware of clients' abuse histories. In order to address this, a Mental Health Trusts Collaboration Project of nine trusts was formed, which piloted delivering the Department of Health's Victims of Violence & Abuse Prevention Programme one-day education and training course regarding enquiring about histories of sexual abuse to various mental health practitioners. This hoped to educate practitioners in factors associated with victims and offenders, improve confidence and competence in asking about client's history of abuse and to increase awareness of the importance of asking. The purpose of this paper is to describe the impact of this course on mental health professionals' practice and attitudes in one of these nine trusts. It was found that since the delivery of the course, 44% (n= x) of professionals had been asking about abuse in 75,100% of cases. Gender, age and diagnosis of both the service users and the practitioners were all identified as factors potentially affecting practitioners' willingness to ask about abuse. Most importantly, 93% (n= x) of participants were found to feel they have the skills and knowledge to enquire about abuse and respond to disclosure in the appropriate way and 77% (n= x) of participants felt that this training had changed their clinical practice. The aim of this evaluation is to prove the effectiveness of the Department of Health's education and training course, which will help towards replicating the project nationally. [source] A narrative review of the Beck Depression Inventory (BDI) and implications for its use in an alcohol-dependent populationJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2010A. MCPHERSON rn ba(hons) bsc Accessible summary ,,The findings from the present study reveal that the Beck Depression Inventory (BDI) is a reliable and valid instrument for measuring depression in a variety of populations. This realization should enable nurses and other health professionals to utilize the tool with added confidence and assurance. ,,The main finding was that the BDI would probably be a reliable and valid screening tool in an alcohol-dependent population. This conclusion appears to echo the relationship that alcohol consumption generally has with depression. This finding is important to those practitioners using the BDI in this population in that it provides further evidence to enhance their practical experience. Abstract A psychometric evaluation of the Beck Depression Inventory (BDI) was carried out on contemporary studies to ascertain its suitability for use in an alcohol-dependent population. Three criteria were used for this: factor analysis, test,retest reliability and internal consistency reliability. Factor analysis revealed that its structure is consistent with either two or three factor models, depending on the population. Test,retest results concluded that the correlation coefficient remained above the recommended threshold and internal consistency reliability highlighted alpha coefficient results consistently above suggested scores, leading to the conclusion that the BDI is probably an effective screening tool in an alcohol-dependent population. [source] The experiences of carers in Taiwanese culture who have long-term schizophrenia in their families: a phenomenological studyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 10 2009X.-Y. HUANG rn msc dnsc Accessible summary ,,Carers in families with long-term schizophrenia in Taiwanese culture are suffering several burdens, such as burdens of caring and emotional burdens. ,,Strategies of coping, cognitive and religious coping strategies were used by carers in order to cope with their burdens. ,,The awareness of such traditional cultural values would help people to provide care in a culturally sensitive manner. Abstract Schizophrenia is a severe illness with little hope of recovery and requires long-term care. The purpose of this study was to explore the experiences of carers who live with someone with long-term schizophrenia, within the cultural context of Taiwan. The study was conducted in a community setting in central Taiwan. A qualitative phenomenological approach was used to explore the experiences of carers. Purposive sampling was used by selecting the carers who were close relatives of the clients, had lived with the clients for at least 1 year and bore most of the responsibilities. Semi-structured face-to-face interviews were conducted to collect the data and narratives were analysed using Colaizzi's (1978) seven-step method. Data saturation was achieved after interviewing 10 carers. Three themes and eight sub-themes were identified: burdens of caring (helping clients' illness, lack of professional support and family conflicts), emotional burdens (sadness, worry and fear) and strategies of coping (cognitive and religious coping strategies). Our study supported the importance for nurses to understand the cultural aspects of mental illness, particularly the widespread cultural beliefs and patterns of help seeking behaviours, in order to provide culturally sensitive health care. [source] Are chronic fatigue syndrome and fibromyalgia the same?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 10 2009Implications for the provision of appropriate mental health intervention Accessible summary ,,This paper views the historical perspectives of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia (FM) that gives an understanding of the background to these complex syndromes. ,,The relationship between CFS/ME and FM are considered based on the evidence presented, which identifies that there is compelling evidence that these two syndromes may in fact be the same. This is interesting as current evidence suggests that these two syndromes are currently treated differently. ,,The long-standing controversy surrounding the aetiology CFS/ME is discussed in relation to the issues of mental health, in particular anxiety and/or depression that has been associated with this condition. In contrast, FM is reviewed in relation to the associated symptomology of anxiety and/or depression. ,,This review provides the reader with compelling evidence to suggest that the initial presenting symptoms of these two diseases may dictate differential diagnosis and the subsequent treatment they receive if any and, moreover, if indeed these syndromes are confused with that of a psychiatric disorder. ,,This paper will give the reader time for thought over the issue that: just because there is at present no specific diagnostic test or treatment for this condition, why then is the conclusion reached that this must be a psychiatric condition. Abstract Chronic fatigue syndrome and fibromyalgia represent distinct diagnostic entities within both the clinical and research literature. A common feature of both presentations is that they are often accompanied by a significant mental health burden. A further salient feature of both conditions is that there is no consistent consensus on aetiology. Evaluation of the features of each disorder seems to present a convincing case that both disorders may indeed have a common aetiology and further, the possibility exists that chronic fatigue syndrome and fibromyalgia represent the same underlying disorder. Paradoxically, given this possibility it is remarkable that both patient groups are treated clinically with considerably different approaches to care and management. Mental health practitioners will come into contact with both groups of patients when support for the psychological consequences of diagnosis are necessary; however, many practitioners will be unaware of the debate regarding the aetiological ambiguities surrounding these presentations. The purpose of this review is to highlight the above issues in order to both facilitate awareness of the current aetiological/diagnostic impasse and facilitate provision of optimum mental health support. [source] Can the introduction of a quality of life tool affect individual professional practice and the quality of care planning in a community mental health team?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 10 2009N. MURPHY rmn dip he bsc (hons) msc pgchepr Accessible summary ,,Audit should not be restricted to one form of methodology and should embrace mixing methods of data collection. ,,Use of a quality of life tool allows users more of a voice, enhancing the partnership with service providers and presenting an alternate view of risk. ,,Implementation of any change to practice needs to address local level barriers and engage the service providers in the process, therefore, avoiding the common perception of being given more work without negotiation and feelings of alienation. Abstract This practice development paper demonstrates the scope for creativity in mixing audit and methods of investigation. It details the evolution of Quality of Life (QOL) perspectives and relates them to the practice of care planning. The process proved enlightening and affirming to practitioners and engaged them in considering value-based practice (recovery-orientated) from the perspective of the client. It was clear that subtle changes to care planning emerged, and the goal of giving responsibility for self determining issues was addressed. [source] Parental mental illness: a review of barriers and issues for working with families and childrenJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2009D. MAYBERY phd Accessible summary For the psychiatric workforce to become family focused (particularly in relation to children) there is a clear need for family sensitive policies and procedures, managerial and organizational support and well-targeted and sustained workforce training. However, there are multiple barriers to the adult mental health workforce becoming family focused including: ,,Some adult mental health services do not identify consumers who are parents and subsequently do not respond to children, parenting and family needs. ,,Organizations often do not have adequate family and child friendly policies and procedures. ,,The adult mental health workforce lacks skills and knowledge about families, children and parenting. ,,The workforce needs to increase encouragement of consumers to include family members and dependent children in treatment of the ill parent including the provision of psycho-education. Abstract Many consumers of psychiatric services are parents, making these services the opportunistic point for supporting consumers' children. While evidence suggests that assisting such children improves their mental health, there is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This paper summarizes the constraining barriers and issues for the psychiatric workforce according to: (1) policy and management; (2) interagency collaboration; (3) worker attitude, skill and knowledge; (4) the parent-consumer; and (5) the consumer's family, including children. Potential solutions are presented, with a particular focus on the hierarchical nature of these barriers. Recommendations are made, including organizational audits to identify the most pressing barriers that impede family sensitive practice. [source] Self-help CBT for depression: opportunities for primary care mental health nurses?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2009A. E. WARRILOW rn(mental health) bn(hons) Accessible summary ,,There is currently a big demand for effective and accessible treatments for common mental health problems, but waiting lists are often long. ,,The aim of this review is to discover whether self-help cognitive behavioural therapy materials are effective in the treatment of depression. ,,It explores a possible role for mental health nurses within primary care to provide access to and low-level support with, these materials. ,,A possible model for organizing such a service is suggested. Abstract Mental health treatments that are effective and accessible to the general population are in high demand. Cognitive behavioural therapy (CBT) has been shown to be effective and is popular but such treatments are difficult to access especially within primary care, causing delay, frustration and suffering. One approach to meeting demand would be through the use of self-help CBT materials that aim to address common mental health problems such as depression. The aim of this review is to discover whether self-help CBT materials are effective in the treatment of depression and how mental health nurses within primary care can use their skills to provide access and low-level support. Studies critiqued within this literature review indicate that self-help CBT is effective for the treatment of depression. However, there is a lack of evidence that specifically considers self-help CBT for the treatment of depression in primary care. This review addresses the question of how much nurse client contact is needed to provide adequate support for the facilitation of self-help CBT in depression with primary care patients and recommends the use of a service delivery model. However, more research needs to be carried out on the application of self-help CBT for depression in primary care. [source] Awareness of early warning signs and help-seeking behaviours among patients with schizophrenia who utilize social rehabilitation facilities in JapanJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2009R. KOICHI rn phn ms Accessible summary ,,Schizophrenia is characterized by the occurrence of psychotic relapses. When this happens, early warning signs such as delusions, hallucinations, thought incoherencies and serious chaotic behaviours occur. ,,In this study, 56.5% of participants who had a history at least one early help-seeking behaviour when they deteriorated was recognized from the following signs: sleep disorders, depression, hallucinations, nervousness, anxiety, fatigue, delusions, illusions and suicidal ideation. ,,Early help-seeking behaviours were related to the following factors: recognition of early warning signs during deterioration, consultation with non-professional and professional support persons during deterioration; consulting with public mental health workers; and living with family. Abstract The purpose of this study was to examine the relationship between early warning signs (EWS) and early help-seeking behaviours (HSB) and to identify the characteristics of patients with schizophrenia who sought early help. A cross-sectional study was carried out in 2004 using a self-reported questionnaire. Participants were recruited from social rehabilitation facilities for the mentally ill; 224 subjects participated, 170 of whom had schizophrenia. The survey included questions about demographic characteristics, self-care behaviours (HSB, recognition of EWS and others) and current service utilization and satisfaction. Fisher's exact test and Student's t -test were used to compare the characteristics of study participants. Logistic regression analyses were used to examine the association between recognition of EWS and early HSB. We found that 96 (56.5%) of 170 patients with schizophrenia reported at least one occasion of early HSB during their deterioration. Early HSB were related to the following factors: recognition of EWS, consultation with non-professional and professional support persons during deterioration, consulting with public mental health workers and living with family. Care and support should be offered to patients with schizophrenia to enable them to recognize their own mental deterioration. [source] Epiphanies and research in the field of mental healthJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2009J. LEES phd ma dipcouns dipsup, cert time-limited therapy pgce mbacp(snr accred) ukrc registered independent counsellor Accessible summary ,,This article looks at the richness inherent in our life experience and engages on a journey to examine this richness in the light of two experiences (or epiphanies) on a clinical training course. It demonstrates how, as a result of continued refection and reflexive analysis, my understanding of these experiences transformed over a period of time. ,,The field of inquiry was a training in psychoanalytic counselling. My ongoing analysis of the experiences provided an evaluation of some key features of that culture and the nature of clinical training, particularly in psychoanalytic milieu. ,,The article concludes with a discussion about the academic culture in which I am now working and the way in which it influences my writing style (in, for example, this article). It concludes that the discourse of this culture prevents us from reaching our creative spiritual core and examines how we can overcome this limitation. Abstract In this paper I will argue that investigating our professional experiences can enrich our understanding, widen our perspective, transform our inner lives and create an endless source of discovery about ourselves, society and the professional discursive systems that we inhabit. I will call such events, after Denzin's work in 1989, epiphanies. In order to develop the theme I will give an account of my own experience of two such epiphanies on a psychoanalytic training course in counselling. I will then present my reflexive analysis of these events over the years, including my reflections on the peer review comments for this paper, and finish with some questions arising out of the study relating to the current status of nursing as an academic profession. [source] Are stigma experiences among persons with mental illness, related to perceptions of self-esteem, empowerment and sense of coherence?JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2009B. LUNDBERG rn rnt Accessible summary ,,The findings from the present study revealed that people with mental illness are often exposed to social rejection from friends and the public. The most common experiences concerned is to be treated differently, or as less competent, after being a patient in mental health care. ,,The main finding of this study was that more rejection experiences were associated with lower level of sense of coherence and, to a lesser extent, with lower level of empowerment and self-esteem. ,,The weak association, between enacted stigma and self-esteem, as well as empowerment and sense of coherence, seems encouraging. However, further research and interventions may also pay attention to felt or anticipated stigma among mentally ill persons. Abstract The aim of the study was to explore the relationship between stigmatizing rejection experiences and self-related variables. Our hypothesis was that rejection experiences would be negatively associated with perceptions of self-esteem, empowerment and sense of coherence. A cross-sectional study assessing rejection experiences, empowerment, sense of coherence and self-esteem was performed, including 200 persons in current or earlier contact with mental health services. The results showed that experiences of rejection were negatively associated with sense of coherence, empowerment and self-esteem. This exploratory investigation suggests that experiences of rejection might be a target for coping interventions. Mental health nurses are in a key position to identify patients' experiences of stigma and by that to understand what consequences of devaluation/discrimination can have for the afflicted. [source] | ||||||||||