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Kernot J, Goh J, Aguilar A, Muller J, Dawson S. Individual placement and support: A qualitative investigation of carers' experiences supporting someone experiencing mental illness into employment. Aust Occup Ther J 2024; 71:240-250. [PMID: 38110830 DOI: 10.1111/1440-1630.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Unemployment rates for people living with mental illness remain persistently high. Individual Placement Support (IPS) is an evidence-based employment model that supports people with severe mental illness to gain employment. Although carers provide emotional and instrumental support for people with mental illness, there is limited research exploring carers' perspectives of IPS. AIMS To explore carers' perspectives of their experience as caregivers of individuals living with mental illness who have participated in IPS. METHODS This qualitative descriptive study gained carers' perspectives through semi-structured interviews. A convenience sample of eight carers was recruited via a community mental health service in Adelaide. Data were analysed thematically. FINDINGS Three main themes were identified: (1) employment benefits, (2) factors that may impact on employment, and (3) knowledge and opinions of IPS. Within each theme, four sub-themes emerged. CONCLUSIONS This study addresses a gap in research and provides insights into carers' experiences of IPS. Increased communication and involvement of carers in IPS may benefit IPS participants and staff as carers provide invaluable additional insight into supporting individuals through their employment journey.
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Affiliation(s)
- Jocelyn Kernot
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Jiin Goh
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Alejandra Aguilar
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Jess Muller
- Allied Health & Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Suzanne Dawson
- Caring Futures Institute, Flinders University, Adelaide, South Australia
- Southern Adelaide Local Health Network, Adelaide, South Australia
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Pritchard A, Coffey M, Rance J. Striking the Right Balance and Supporting Social Aspirations: How Agency and Choice Play out in a Recovery-Oriented Mental Health Service. Issues Ment Health Nurs 2023; 44:1237-1244. [PMID: 37819779 DOI: 10.1080/01612840.2023.2260472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION There has been an increasing drive for a transformation of the mental health system towards recovery orientation, with research identifying a series of key recovery principles. It has been argued that these principles remain rhetoric rather than routine practice, and it remains unclear how these are operationalised and promoted within inpatient settings. AIM To address the knowledge gap of how staff and service-users enact recovery principles during the daily workings of an inpatient mental health service. METHOD Twenty-one interviews were conducted with staff and service-users at a recovery-oriented inpatient service in the United Kingdom. Data was analysed using framework analysis. FINDINGS Analysis of research interview data identified three subcategories grouped under the category of choice. These categories were: a delicate balancing act, acceptability of choices, and social issues impacting choice. DISCUSSION Staff were uncertain of their role in promoting choice, resulting in service-users feeling unsupported in their recovery. Staff had to adopt a titrated approach to social inclusion, to protect service-users from discrimination and rejection. IMPLICATIONS Mental health professionals need to take a more proactive role in enabling service-users to realise their social aspirations, as well as managing any adverse impacts of stigma and discrimination.
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Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Newton A, Downs J, Lovell K, Bee P, Cherry MG, Young B, Vassilev I, Rotheram C, Rogers A. Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom. BMC Health Serv Res 2022; 22:1140. [PMID: 36085063 PMCID: PMC9461266 DOI: 10.1186/s12913-022-08521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists. Aim To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources. Methods In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues. In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation. Results Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention. Conclusion The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08521-1.
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Delaney KR, Loucks J, Ray R, Blair EW, Nadler-Moodie M, Batscha C, Sharp DM, Milliken D. Delineating Quality Indicators of Inpatient Psychiatric Hospitalization. J Am Psychiatr Nurses Assoc 2022; 28:391-401. [PMID: 33190586 DOI: 10.1177/1078390320971367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assuring quality care is critical to the well-being and recovery of individuals receiving inpatient psychiatric treatment, yet a comprehensive map of quality inpatient care does not exist. AIMS To isolate and describe quality elements of inpatient psychiatric treatment. METHODS A survey queried psychiatric inpatient nursing leaders on what they considered to be critical elements of quality. The survey was emailed to 40 American Psychiatric Nurses Association members, and 39 individuals responded. In the survey, participants were asked to comment on the importance of six dimensions of quality as well as quality indicators used on their units. RESULTS Data from this survey indicate how thought leaders conceptualized quality of inpatient care. A unifying philosophy of care was endorsed as a quality element as was structure that affords staff available time on the unit-engaging with patients. While staffing levels were viewed as important, the respondents commented on the nuances between staffing and quality. Participants endorsed the importance of involving individuals in their treatment planning as well as tapping into patients' perspectives on the treatment experience. CONCLUSIONS The participants' responses compliment the quality literature and reinforce the need to develop a comprehensive map of quality elements. These elements interact in complex way, for instance, staffing, engagement, and teamwork is tied to the organizational structure and philosophy of care, which in turn facilitates consumer involvement in care. Thus, gauging the impact of quality on outcomes will demand consideration of the interaction of factors not just the linear relationship of one element to an outcome.
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Affiliation(s)
- Kathleen R Delaney
- Kathleen R. Delaney, PhD, PMH-NP, FAAN, Rush College of Nursing, Chicago, IL, USA
| | | | - Richard Ray
- Richard Ray, MS, RN, PMH-BC, Northwestern Memorial Hospital Stone Institute of Psychiatry, Chicago, IL, USA
| | - Ellen W Blair
- Ellen Blair, DNP, APRN, PMHCNS-BC, Hartford Hospital, Hartford, CT, USA
| | - Marlene Nadler-Moodie
- Marlene Nadler-Moodie, MSN, APRN, PMHCNS-BC, Scripps Mercy Hospital San Diego, CA, USA
| | - Catherine Batscha
- Catherine Batscha, DNP, RN, University of Louisville, Louisville, KY, USA
| | - David M Sharp
- David Sharp, PhD, RN, Mississippi College, Clinton, MS, USA
| | - Dani Milliken
- Dani Milliken, DHA, MS, BSN, RN, Children's Hospital of Orange County, Orange, CA, USA
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Maples NJ, Velligan DI, Jones EC, Espinosa EM, Morgan RO, Valerio-Shewmaker MA. Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry. Community Ment Health J 2022; 58:578-588. [PMID: 34176054 PMCID: PMC8860777 DOI: 10.1007/s10597-021-00856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.
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Affiliation(s)
- Natalie J Maples
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA.
- Department of Psychiatry and Behavioral Sciences, MS7797, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Dawn I Velligan
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, UT School of Public Health, El Paso, TX, USA
| | | | - Robert O Morgan
- Department of Management, Policy, and Community Health, UT School of Public Health, Houston, TX, USA
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Hannigan B. Observations from a small country: mental health policy, services and nursing in Wales. HEALTH ECONOMICS, POLICY, AND LAW 2022; 17:200-211. [PMID: 33455606 DOI: 10.1017/s1744133120000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Wales is a small country, with an ageing population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the UK. This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.
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Affiliation(s)
- Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB, UK
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7
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Zang Y, Liu S, Chen Y. Qualitative study of willingness and demand for participation in decision-making regarding anticoagulation therapy in patient undergoing heart valve replacement. BMC Med Inform Decis Mak 2022; 22:45. [PMID: 35180869 PMCID: PMC8857803 DOI: 10.1186/s12911-022-01780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Promoting patient participation in decision-making aims to maintain the partnership between doctors and patients, reflect the patients’ goals, values, and preferences, and achieve patient-centered care. Realizing patient-centered care, shared collaboration between doctors and patients, and the decision-making process that considers the patients’ priorities and goals are the keys to high-quality health care. Therefore, it is indispensable to analyze the patients’ willingness to participate in the decision-making process and related participation needs regarding anticoagulation treatment for patients undergoing valve replacement. Purpose To analyze the patients’ willingness to participate in the decision-making process and the participation needs of patients undergoing mechanical cardiac valve replacement in the process of anticoagulation therapy to provide a basis for promoting patients' participation in decision-making. Methods Using phenomenological research methods, data were collected through semistructured interviews. Patients were interviewed after mechanical valve replacement from June to August 2021 in a Grade A hospital in Nanjing. Data were analyzed according to the Colaizzi phenomenology method. Results Three major themes were identified from the data: strong willingness to participate but low actual participation, supportive needs, and family members’ participation. Conclusions This study guided interventions to encourage patients who underwent heart valve replacement to participate in the decision-making process. From the patient's perspective, obtaining support in the decision-making process and caregiver enthusiasm is important. This study prompted thoughts about the use of auxiliary tools and provided a reliable basis for constructing decision-making auxiliary programs to guide clinical practice.
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Affiliation(s)
- YaNing Zang
- The Third School of Clinical Medicine, Nanjing Medical University, Qinhuai District, Nanjing City, Jiangsu Province, China
| | - ShanShan Liu
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, Nanjing City, Jiangsu Province, China
| | - YuHong Chen
- Department of Nursing, Nanjing First Hospital, Nanjing Medical University, Qinhuai District, Nanjing City, Jiangsu Province, China.
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Levin L. Perspective: Decolonizing postmodernist approaches to mental health discourse toward promoting epistemic justice. Front Psychiatry 2022; 13:980148. [PMID: 36276325 PMCID: PMC9582654 DOI: 10.3389/fpsyt.2022.980148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, it is possible to observe a slowly (but surely) growing volume of claims seeking to disprove Foucauldian ideas about knowledge and power as overlapping basic theories of epistemic justice. Prompted by these claims, alongside adopting tenets of Critical Race Theory to address injustices inflicted upon people facing mental health challenges, I propose applying decolonizing deconstruction to Foucault's terminology, toward identifying opportunities to enhance epistemic justice, primarily in direct interventions in mental health services.
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Affiliation(s)
- Lia Levin
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Jose AL, Harrison M, Roy AS, Fitzpatrick LI, Forsyth K. The level of formal support received by people with severe mental illness living in supported accommodation and participation: A systematic review. Int J Soc Psychiatry 2021; 67:854-866. [PMID: 33487055 PMCID: PMC8559179 DOI: 10.1177/0020764020988576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The review aimed to identify and explore the association of level of support received by people with severe mental illness in supported accommodation and participation. METHOD The authors conducted a systematic search in MEDLINE, PsychINFO, PsychARTICLES, CINAHL Plus and ASSIA. Searches were restricted to articles published in English and participants aged 18 years and over with severe mental illness. Articles were included based on level of support received in mental health supported accommodation, classified according to the Simple Taxonomy for Supported Accommodation, and three factors of participation: social participation, daily living functioning and personal empowerment. Studies of in-patient settings and nursing homes were excluded. The review protocol is registered on PROSPERO (registration number: CRD42019161808). RESULTS Six articles were included in the review from USA, Australia, Sweden and Taiwan. Factors of participation for people living in accommodation with moderate support and accommodation with high support were explored. Data indicated an association between level of support and participation showing that people living in accommodation with moderate support had increased participation compared to people living in accommodation with high support. CONCLUSION This review identified an association between level of formal support and participation. People with SMI living in accommodation with medium support participated in more community occupations, more activities and had a higher level of personal empowerment than people living in accommodation with high support.
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Affiliation(s)
- Akkara Lionel Jose
- School of Health Sciences, Queen
Margaret University, Queen Margaret University Drive, Edinburgh, UK
| | - Michele Harrison
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
| | - Anusua Singh Roy
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
| | - Linda Irvine- Fitzpatrick
- Strategic Programme Manager, Mental
Health and Wellbeing, City of Edinburgh Health and Social Care Partnership,
Edinburgh, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen
Margaret University, Edinburgh, UK
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10
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Dawson S, Muir-Cochrane E, Simpson A, Lawn S. Community treatment orders and care planning: How is engagement and decision-making enacted? Health Expect 2021; 24:1859-1867. [PMID: 34382300 PMCID: PMC8483198 DOI: 10.1111/hex.13329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery‐focussed. Key components in the care planning process include engagement and decision‐making about a person's support needs and care options, with trust being an essential component of care planning relationships. Objective This study examines how these components were enacted during service care contacts for individuals on community treatment orders. Methods The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day‐to‐day care interactions. Results Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of ‘knowing’, with consumers assumed to have less knowledge than clinicians. Conclusions Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision‐making. Patient or Public Contribution This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.
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Affiliation(s)
- Suzanne Dawson
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alan Simpson
- Health Service and Population Research Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Carrotte ER, Hartup ME, Lee-Bates B, Blanchard M. "I think that everybody should be involved": What informs experiences of shared decision-making in supporting people living with schizophrenia spectrum disorders? PATIENT EDUCATION AND COUNSELING 2021; 104:1583-1590. [PMID: 33229188 DOI: 10.1016/j.pec.2020.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/11/2020] [Accepted: 11/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To identify facilitators and barriers associated with shared decision-making (SDM) in Australians affected by schizophrenia spectrum disorders. METHODS We surveyed 78 participants with lived experience and held 12 in-depth interviews, including seven carers. RESULTS A multiple linear regression model identified two independent variables significantly associated with degree of SDM: Personal Wellbeing Index scores (ß = .32, t = 3.3, p = .001) and treatment satisfaction rating (ß =.46, t = 4.7, p < .001), indicating that higher personal wellbeing and higher treatment satisfaction were significantly related to higher degree of SDM. Two key themes were identified through interview data: a complex pathway to SDM and impacts on wellbeing. Sub-themes included: self and carer characteristics, holistic care, education and knowledge, and power balance. Generally, participants reported a desire for SDM, noting that healthcare professionals inconsistently involve them in treatment decisions. CONCLUSION SDM is associated with treatment satisfaction and personal wellbeing among people living with schizophrenia spectrum disorders, but can be difficult to implement due to a range of challenges. PRACTICE IMPLICATIONS There is a need to improve SDM in this population by decreasing stigma and discrimination, balancing power in consultations, increasing access to holistic treatment, and improving education and knowledge.
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Affiliation(s)
| | | | - Benjamin Lee-Bates
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia.
| | - Michelle Blanchard
- Anne Deveson Research Centre, SANE Australia, South Melbourne, Australia; School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
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12
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Hankle ZJ, Bluestone DC, Kramer JK, Bassi P, Goreczny AJ. What activities individuals with intellectual disabilities do for fun: exploration into self-care. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:712-722. [PMID: 36210892 PMCID: PMC9543174 DOI: 10.1080/20473869.2021.1884788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/28/2020] [Accepted: 01/26/2021] [Indexed: 06/16/2023]
Abstract
Participation in enjoyable activities is instrumental to improving individuals' quality of life. Previous studies have indicated engagement in community-based activities and physical exercise are beneficial to individuals with intellectual disabilities (ID). The purpose of this study was to understand, from their perceptions, fun activities in which individuals with ID engaged. One hundred and sixty-nine participants with ID provided 561 responses, which described what they do for fun. A multidisciplinary research team utilized a Consensual Qualitative Research (CQR) approach to differentiate responses into a list of categories that fit into six central domains. Domains (with frequency of responses) included: Community and Relationship Building Activities (130), Sports and Other Physical Activities (123), Technology and Gaming (105), Music and Other Preforming Arts (69), Mentally-Stimulating Activities (51), and Categories Outside of a Domain (82). These findings indicate that individuals with ID have a variety of interests. Our discussion, which reviews literature on individuals with and without ID, suggests similar leisure activity engagement among both groups. This literature also suggests individuals with ID experience similar benefits to their peers without ID when engaging in leisure activities. Our results provide a framework to explore self-care routines that can improve quality of life for individuals with ID.
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Affiliation(s)
| | | | | | - Palak Bassi
- Graduate Psychology, Chatham University, Pittsburgh, PA, USA
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13
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Smartphone-Based Assessment of Preoperative Decision Conflict and Postoperative Physical Activity Among Patients Undergoing Cancer Surgery: A Prospective Cohort Study. Ann Surg 2020; 276:193-199. [PMID: 32941270 DOI: 10.1097/sla.0000000000004487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of clinically significant decision conflict (CSDC) among patients undergoing cancer surgery and associations with postoperative physical activity, as measured through smartphone accelerometer data. BACKGROUND Patients with cancer face challenging treatment decisions, which may lead to CSDC. CSDC negatively affects patient-provider relationships, psychosocial functioning, and health-related quality of life; however, physical manifestations of CSDC remain poorly characterized. METHODS Adult smartphone-owners undergoing surgery for breast, skin-soft-tissue, head-and-neck, or abdominal cancer (July 2017-2019) were approached. Patients downloaded the Beiwe application that delivered the Decision Conflict Scale (DCS) preoperatively and collected smartphone accelerometer data continuously from enrollment through 6 months postoperatively. Restricted-cubic-spline regression, adjusting for a priori potential confounders (age, type of surgery, support status, and postoperative complications) was used to determine trends in postoperative daily physical activity among patients with and without CSDC (DCS score≥25/100). RESULTS Among 99 patients who downloaded the application, 85 completed the DCS (86% participation rate). Twenty-three (27%) reported CSDC. These patients were younger (mean age 48.3 [standard deviation 14.2]-vs.-55.0 [13.3],p = 0.047) and more frequently lived alone (22%-vs.-6%,p = 0.042). There were no differences in preoperative physical activity (115.4 minutes [95%CI 90.9,139.9]-vs.-110.8 [95% 95.7,126.0],p = 0.753). Adjusted postoperative physical activity was lower among patients reporting CSDC at 30 days (difference 33.1 minutes [95%CI 5.93,60.2],p = 0.017), 60 days (35.5[95%CI 8.50,62.5],p = 0.010) and 90 days (31.8[95%CI 5.44,58.1],p = 0.018) postoperatively. CONCLUSIONS CSDC was prevalent among patients who underwent cancer surgery and associated with lower postoperatively daily physical activity. These data highlight the importance of addressing modifiable decisional needs of patients through enhanced shared decision-making.
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Dhaliwal K, Danzig A, Fineberg SK. Improving Research Practice for Studying Borderline Personality Disorder: Lessons From the Clinic. ACTA ACUST UNITED AC 2020; 4:2470547020912504. [PMID: 32518886 PMCID: PMC7254581 DOI: 10.1177/2470547020912504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/23/2020] [Indexed: 12/25/2022]
Abstract
Borderline personality disorder is an often misunderstood and underdiagnosed mental illness characterized in part by affective lability. Clinicians’ unique understanding of the disorder has allowed them to develop disorder-specific approaches to treatment. In this review, we highlight how borderline personality disorder research can benefit from greater engagement with key disorder-specific features, including symptom variability and interpersonal sensitivity. In addition, we propose that research which employs interactive tasks will be more reflective of the kinds of volatility found in the real-life situations. Finally, we discuss how mixed-methodology can serve as a way for recovery-oriented research to practice the very ideals and recommendations it suggests. We use a patient case to contextualize each section. As interest in borderline personality disorder continues to grow, an intentional emphasis on a person-centered, recovery-focused, and disorder-specific approach to research is needed.
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Affiliation(s)
- Khushwant Dhaliwal
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ayala Danzig
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah K Fineberg
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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15
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Lin CY, Renwick L, Lovell K. Patients' perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30316-5. [PMID: 32487469 DOI: 10.1016/j.pec.2020.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. METHODS Qualitative semi-structured interviews were used to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. Individual semi-structured interviews were conducted from July to August 2017 with a purposive sample of twenty patients using halfway houses. Data were analysed using thematic analysis. RESULTS Analysis of the interviews identified two themes: barriers to shared decision making; facilitators of shared decision making. Patients perceived that they were not involved in decision making due to: the professional status of health professionals; negative perception of making decisions; and limited time resources. However, patients reported a desire to be involved and felt sufficient information exchange would be a necessary step towards collaboration/sharing decisions about treatment with clinicians. CONCLUSION The findings provided an understanding of significant barriers to and facilitators of implementing shared decision making to aid further professional training and the development of national policies. PRACTICE IMPLICATIONS The findings could be the basis for developing effective strategies to overcome barriers to shared decision making and improve the process quality of delivering shared decision making.
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Affiliation(s)
- Chiu-Yi Lin
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Laoise Renwick
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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16
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Dawson S, Muller J, Renigers V, Varona L, Kernot J. Consumer, health professional and employment specialist experiences of an individual placement and support programme. Scand J Occup Ther 2020; 28:433-445. [PMID: 31976792 DOI: 10.1080/11038128.2020.1714719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Individuals with severe mental illness (SMI) are under-represented in the workforce. The Individual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support individuals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. AIM To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. METHODS Qualitative descriptive methodology explored consumers (n = 11), health professionals and employment specialist (n = 11) perceptions and experiences of the IPS programme. Semi-structured interviews were conducted and thematically analysed. RESULTS Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. CONCLUSION Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. SIGNIFICANCE IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.
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Affiliation(s)
- Suzanne Dawson
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Jessica Muller
- Department of Rural Health, Division of Health Sciences, University of South Australia, Whyalla, Australia
| | - Vic Renigers
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Lisa Varona
- Central Adelaide Local Health Network, Mental Health Directorate, Adelaide, Australia
| | - Jocelyn Kernot
- Occupational Therapy Program, School of Health Science, University of South Australia, Adelaide, Australia
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Ding J, Jia Y, Zhao J, Yang F, Ma R, Yang X. Optimizing quality of life among Chinese physicians: the positive effects of resilience and recovery experience. Qual Life Res 2020; 29:1655-1663. [DOI: 10.1007/s11136-020-02414-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
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18
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Prat G, Ribot A, Recoder S, Muñoz F. Psychometric properties of the Spanish version of the Engagement in Meaningful Activities Survey in people with serious mental illness. Br J Occup Ther 2019. [DOI: 10.1177/0308022619856557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gemma Prat
- Grup SaMIS, Divisió de Salut Mental, Fundació Althaia, Manresa (Barcelona), Spain
| | - Arantxa Ribot
- Leisure-Community Intervention, Federació Salut Mental Catalunya, Barcelona, Spain
| | - Sílvia Recoder
- Departament de Ciències Bàsiques, Àrea de Psicologia, Universitat Internacional de Catalunya, Sant Cugat del Vallés (Barcelona), Spain
| | - Francisco Muñoz
- Leisure-Community Intervention, Federació Salut Mental Catalunya, Barcelona, Spain
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