A randomized controlled trial of a mutual support group for family caregivers of patients with schizophrenia

This randomized controlled trial examined the effectiveness of a 12-session mutual support group conducted over 3-months for Chinese family caregivers of a relative with schizophrenia compared with routine family support services in Hong Kong. Forty-eight family caregivers from two psychiatric outpatient clinics were allocated randomly to an experimental (mutual support and usual outpatient care) group (n = 24) or a control (usual outpatient care only) group (n = 24). Data were collected prior to, 1 week and 3 months after the intervention. Families allocated to the mutual support group experienced decreased levels of family burden and increased family functioning and these changes were significantly greater than those of the controls at both post-intervention time points. The experimental group also showed a significant decrease in the duration of patient re-hospitalization (the total number of days of psychiatric hospitalization) at 3 months compared with the control group. This suggests that the mutual support group provided a more responsive service for patients than standard care. However, there was no significant difference in family service utilization between the two groups. The findings indicate that a mutual support group can provide benefits for family caregivers of people with schizophrenia that go beyond those provided by routine family support.

The Validity and Reliability of a Chinese Version of the Family Burden Interview Schedule

BACKGROUND

The caregiver burden within the family is one of the most commonly used outcome variables in research studies of patient care provision. However, few measures of family caregiver burden have been validated for use with Asian populations.

OBJECTIVE

To examine the reliability and validity of the Chinese version of the Family Burden Interview Schedule.

METHOD

The first phase of the investigation involved translation and back translation of the measure for burden and a review by an expert panel. In this phase, equivalence between the Chinese and English versions, content validity, and test-retest reliability of the Family Burden Interview Schedule were assessed using a sample including 30 family caregivers of mental patients. The second phase established the internal consistency and construct validity of the scale using a sample comprising 185 family caregivers of patients with schizophrenia. Sensitivity of the scale for families of schizophrenic patients was examined through comparison with 40 caregivers of patients who had major affective disorder.

RESULTS

The Chinese version of the Family Burden Interview Schedule adequately addressed the original concepts and dimensions, achieving 96% on the Content Validity Index. These results demonstrated high levels of equivalence with the original English version (intra-class correlation [ICC] of .87 for the overall scale and.80-.89 for the six domains). It also demonstrated a high internal consistency (Cronbach alpha of .87 for the scale and .78-.88 for the domains) and adequate test - retest response stability (r = .83 for the scale and r = .88-.92 for the domains). The mean scores for the overall scale and domains of the Family Burden Interview Schedule differed significantly between the family providers of care for the two illness groups and between the groups with high and low time involvement in caregiving. The principal components analysis showed the presence of five factors that together explained 65.85% of the variance. It also demonstrated high factor loadings as well as item-to-scale and between-subscales intercorrelations, indicating good construct validity of the burden measure.

DISCUSSION

The findings for the psychometric properties of the Chinese version of the Family Burden Interview Schedule established its potential as a research instrument for measuring caregiver burden among Chinese patients with schizophrenia.

Barriers to research utilisation among forensic mental health nurses

This study used a cross-sectional, descriptive design to identify barriers to research utilisation among forensic mental health nurses. A postal questionnaire was sent to the total population of 88 registered nurses working in a forensic mental health hospital in the UK. Forty-seven responded representing a response rate of 53%. Results showed that the greatest barriers to research utilisation were those related to the characteristics of the setting in which nurses work or the personal characteristics of nurses themselves, which seems to be consistent with previous studies undertaken in the area. However, the nurses reported it especially difficult to trust what research shows because they feel that it is not always possible to apply those findings to their particular work environment. The main implications for policy are a need for an increase in support from management, programmes of advanced education to provide nurses with research skills, an improvement in accessibility and availability of research reports and an increase in time available to read and implement research. The main suggestions for future research are that qualitative studies should be carried out to attain a better understanding of mental health nurses' attitudes towards research utilisation.

NHS cadet schemes: student experience, commitment, job satisfaction and job stress

In the context of various policy initiatives concerning widening access to and strengthening recruitment and retention in the health services, cadet schemes--predominantly in nursing--have proliferated over the last few years. As part of a larger national evaluation of National Health Service (NHS) cadet schemes, this paper reports on a survey of senior cadet students across 62 cadet schemes in England and examines their experience of being a cadet on such a scheme. Cadets forming the most senior cohort from each of the 62 schemes (n = 596) were surveyed using a questionnaire. The questionnaire included self-rated measures of job satisfaction, job stress and commitment. A 5% sample of these cadets participated in follow-up telephone interviews. Cadets reported high satisfaction with their courses. One of the most positive aspects of the schemes was the first-hand experience of working in the NHS they provided, whilst also giving cadets the opportunity to gain recognisable skills and qualifications. Cadets scored highly on the job satisfaction scale and, on the job stress scale, showed low stress overall. A significant positive correlation was found between satisfaction and stress, indicating that the cadets who are most satisfied are also more highly stressed. A negative correlation was found between stress and the dimensions of commitment indicating that those cadets who are stressed are less committed to the NHS. A negative correlation was also found between satisfaction and the dimensions of commitment, suggesting that commitment to the NHS is not contingent on high satisfaction. The implications for the findings of the survey are discussed.

Educational needs of families caring for Chinese patients with schizophrenia

BACKGROUND

Schizophrenia is a disruptive and distressing illness for patients and family members who care for them. As in Western countries more than 20% of people with schizophrenia in Hong Kong are discharged to their homes, but their families are unprepared to care for them. Studies of caregivers' opinions about the information required to supervise patients are limited, particularly for the purposes of optimizing family-centred care.

AIM

The aim of this study was to identify the educational needs of Chinese families caring for a relative with schizophrenia.

METHODS

A cross-sectional survey was conducted in Hong Kong with a random sample of 204 family members caring for a relative with schizophrenia. A Chinese version of the Modified Educational Needs Questionnaire, validated in a previous study, was used to identify educational needs that family caregivers considered important in caring for mentally ill relatives.

FINDINGS

Educational needs perceived as important by caregivers included gaining information about early warning signs of illness and relapse, effects of medication and ways of coping with patients' bizarre and assaulting behaviour. Gender, education level and closeness of the relationship with the patient correlated positively and significantly with need importance. Conversely, the relationship between duration of caring for patient and need importance correlated significantly but negatively, indicating the adverse effect of enduring mental illness on family caregivers' interest in mental health education.

CONCLUSION

This study emphasizes the importance of assessing specific family needs in caring for a relative with mental illness. It also raises concern about the negative effects of the length of time of caring for such patients and the role of socio-economic factors on the perceived educational needs of these families.

Evaluating change in health care practice: lessons from three studies

Implementation and evaluation of evidence-based practice are high on the policy agenda in the UK National Health Service. Over the last 30 years evaluation of practice in the health services has moved from a (medical) profession-led mode to a politically and managerially led mode in which objectives are pre-set by those who legitimate and fund the services. Against this background we describe three recent evaluations of nursing practice as examples to illustrate challenges encountered when evaluating changes in practice developments in health care. If evaluations are to contribute to improvements in practice, a shift is needed from an over-reliance on one-off outcome evaluations to those that have a cumulative component and take account of context and process as well as outcome. The merits of realistic evaluation are suggested as a solution to the methodological limitations of traditional approaches and to developing generalizable theory.

Interprofessional perceptions of health care students

Effective interprofessional working, which is widely considered as essential to high-quality health care, is influenced by the attitudes of health care professionals towards their own and other professional groups. Relatively little is known, however, about interprofessional attitudes, particularly of students in health care professions. This study aimed to increase our understanding of students' attitudes towards their own and other professional groups on entry to a programme of professional education. Hypothesised relationships between stereotypes, professional identity and readiness for professional learning were tested by means of a questionnaire survey of 933 undergraduate health care students drawn from five health care groups (medicine, nursing, dietetics, pharmacy and physiotherapy) within a multi-faculty UK university. Positive statistically significant correlations were found between stereotypes, professional identity and readiness for interprofessional learning. As predicted, students identified strongly with their own professional group at the start of pre-registration education. They were also willing to engage in interprofessional learning. More unexpected was the positive association found between heterostereotype and professional identity scores. There are potential benefits of introducing active interprofessional education activities at an early stage of professional preparation to capitalise on students' positive attitudes towards their own and other professional groups.

Accomplishing care at home for people with dementia: using observational methodology

The authors consider the problems and possibilities presented by using unstructured observation in the home setting. The findings of the original study are described elsewhere (Briggs, Askham, Norman, & Redfern 1998; National Health Service [NHS] Executive 1998). In this article, the authors discuss process issues (e.g., gaining and maintaining access to the research setting, disengaging, what can and cannot be observed, and the validity of the data and analysis), drawing on a study of the nature of care as a form of social organization in the homes of people with dementia. They show that observation is not only possible but, when combined with conversational interviewing, essential for understanding the processes of caring and what it means to live with dementia.

Work satisfaction, stress, quality of care and morale of older people in a nursing home

The aim in the present study, which was carried out in one nursing home for older people, was to determine the feasibility of working with care workers and very frail service users to investigate links between the levels of work satisfaction and stress of the staff, and the quality of care and morale of the residents. Most of the 44 care staff (70%) and 22 cognitively intact residents (82%) participated willingly in completing rating scales through self-completion questionnaire or by interview. Well-validated scales were used to measure job satisfaction, work stress, organisational commitment, perceived quality of care, and morale and mental health. The findings revealed a staff group with a fairly high level of job dissatisfaction and stress, who were, nevertheless, very committed to the nursing home. The morale of the residents was good although the residents rated the home atmosphere lower than the staff did. Significant correlations emerged, in the expected direction, between satisfaction, commitment, stress and quality of care perceived by staff. The correlations between home atmosphere perceived by residents, and their morale and mental health were low; further investigation is needed with a larger sample. This feasibility study supports the need for further research using a case-study approach in a small number of homes because of the labour-intensive nature of the data collection and the importance of triangulating data from many sources.

Assessing practice of student nurses: methods, preparation of assessors and student views

AIMS

To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution.

BACKGROUND

Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable.

METHODS

All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed.

RESULTS

Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views.

CONCLUSIONS

There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.

Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Part 1

The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 includes the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and the conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. Congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis.

Quality of nursing care perceived by patients and their nurses: an application of the critical incident technique. Part 2

The aims of the study were to identify indicators of quality of nursing care from the perceptions of patients and nurses, and to determine the congruence between patients' and nurses' perceptions. The paper is presented in two parts. Part 1 included the background and methods to the study and the findings from the comparison of patients' and nurses' perceptions. Part 2 describes the perceptions of patients and nurses, and draws conclusions drawn from the study as a whole. Patients and nurses in hospital wards were interviewed using the critical incident technique. We grouped 4546 indicators of high and low quality nursing care generated from the interview transcripts into 316 subcategories, 68 categories and 31 themes. The themes were grouped into eight clusters: therapeutic context for care, attitudes and sensitivity, teaching and leadership, motivation to nurse, monitoring and informing, high-dependency care, efficiency and thoroughness, reflection and anticipation. As shown in Part 1 of the paper, congruence between patients' and nurses' perceptions of quality was high and significant, although there was some difference of emphasis. The findings support an emerging theory of interpersonal competence and quality in nursing care.

Nurses' role in supporting people who are HIV positive

This is the second of two papers which report the results of a research study of the psychological and emotional needs of people with HIV disease and how nurses might best offer support. This paper discusses the nurse's role in offering psychological and emotional support to patients. Inductive analysis of in-depth interviews with in-patients and their nurses revealed four aspects of the nursing role that were highly valued: nurses being caring; acting therapeutically; assessing and monitoring patients' changing needs for emotional support; and acting as educators.

Applying triangulation to the assessment of quality of nursing

The claim that generic quality assessment instruments provide an objective assessment of quality of nursing care is questioned. Recent research suggests that most instruments are in need of extensive validity testing, particularly in relation to the concepts that they purport to assess. This paper outlines a research study designed to test the validity of the generic quality assessment instruments, Monitor, Senior Monitor and Qualpacs. In the absence of an independent criterion of quality against which to validate these instruments we propose a multiple triangulation research strategy in order to achieve the goals of 'confirmation' and 'completeness' within the same research design. The research incorporates approaches that purport to focus on quality of nursing care that are complementary to the generic instruments. We pay particular attention to the meanings of quality of nursing to those most closely involved and in positions of expertise--that is, nurses and patients. Comparisons between scores from the generic instruments and data generated by these complementary approaches will enable a more accurate picture of the validity of the generic instruments to emerge. The research should also increase our understanding of the meaning of quality in relation to nursing care.

Psychiatric patients' views of their lives before and after moving to a hostel: a qualitative study

This study focuses upon the experiences of a group of 10 long-stay psychiatric patients as they moved from a large institution to a staffed community hostel. The residents were interviewed 2 weeks prior to moving and again 6 weeks after the move. Areas identified in the first set of unstructured interviews were followed up in the second set. Qualitative analysis of the interviews revealed seven recurrent themes that are discussed in relation to other research studies that consider how people experience the effects of institutionalization. The study tests the feasibility of unstructured interviews as a means of collecting accounts of the perceptions and experiences of a client group from which other research methods have failed to elicit detailed information. Unstructured interviews proved successful when undertaken by a researcher who was well known and accepted by the residents. Familiarity with the residents and the context of the interview was also found to be important in analysing interviews qualitatively and the study casts doubt upon the value of primary qualitative analysis of interview transcripts by researchers who have not also participated in the interviews. The methodological implications for future deinstitutionalization studies are discussed.