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Zomer L, van der Meer L, van Weeghel J, Widdershoven G, de Jong I, Voskes Y. Recovery-oriented care in Teams Working with the ART Model in long-term Mental Health care: A Qualitative Study on the Experiences of Service Users and Their Significant Others. Community Ment Health J 2024; 60:1177-1190. [PMID: 38619696 PMCID: PMC11199278 DOI: 10.1007/s10597-024-01269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024]
Abstract
The Active Recovery Triad (ART) model provides a framework for recovery-oriented care in long-term mental health settings. The aim of this study is to gain insight into the experiences and views of service users and their significant others regarding care and support they receive from teams working with the ART model. Semi-structured interviews were performed with nineteen service users and five significant others of teams operating in Dutch long-term mental health care. Data were analyzed using thematic analysis. The three core principles of the ART model formed the deductive basis of the analysis and for every principle themes were identified inductively. Under the principle 'Active', service users mentioned that they feel motivated, work actively on personal recovery goals and have dreams for the future. Service users valued the service as a safe environment, but several service users also preferred to live more independently. Under the principle 'Recovery', participants reported how the dimensions of recovery (health, personal identity, daily life and community functioning) were addressed in care and support. Also, specific conditions for recovery-oriented care were identified, for example regarding specific expertise of care providers. Under the principle 'Triad' the support from significant others, contact with care workers and with other service users were identified as important. The insights regarding what is important for service users and their significant others may contribute to the improvement of care and support in long-term mental health care. In addition, the findings of this study provide directions for the further development of the ART model.
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Affiliation(s)
- Lieke Zomer
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
- Altrecht GGz, Zeist, the Netherlands.
| | - Lisette van der Meer
- Department of Clinical & Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, the Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Isa de Jong
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
- Impact Care Group, GGz Breburg, Tilburg, the Netherlands
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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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Moureau L, Verhofstadt M, Liégeois A. Mapping the ethical aspects in end-of-life care for persons with a severe and persistent mental illness: A scoping review of the literature. Front Psychiatry 2023; 14:1094038. [PMID: 37009126 PMCID: PMC10062453 DOI: 10.3389/fpsyt.2023.1094038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Persons with severe and persistent mental illness (SPMI) make up a vulnerable group within mental healthcare and society. Not only do they suffer from long-term, serious psychiatric disorders; they often also experience considerable problems in their psychosocial functioning. Research has disclosed that the care needs of this target group are complex, and that the life expectancy of these persons is significantly lower than in the general population. Given (1) the lower life expectancy of persons with SPMI, (2) the higher suicide risk related to mental disorders, and (3) the legalization and practice of medical assistance in dying in an increasing number of countries, it is of utmost importance to map the ethical aspects and challenges of end-of-life care needs in persons with SPMI. Therefore, we charted the way end-of-life care is provided for them by means of a scoping review of the scientific literature, with an emphasis on the ethical aspects surrounding it. We explore existing ethical dilemmas; the underlying ethical values, principles and attitudes; and the locus and stakeholders of ethical dialog regarding end-of-life care in persons with SPMI. The results indicate that the four guiding principles of biomedical ethics can well be identified in the literature, and are each addressed in their own specific way: Autonomy in relation to questions regarding the decision-making capacity of persons with SPMI; Justice in relation to access to quality care and the presence of stigma; and Non-maleficence and Beneficence in relation to the ongoing debate regarding the benefits and obstacles in applying palliative care approaches in the context of psychiatry, and the status of the futility-concept therein. Personal virtues and attitudes in care professionals, like compassion, non-abandonment and upholding dignity are key, as care professionals are the main advocates of persons with SPMI, which often lack an extensive social network. Further, we find that the ethical dialog is mainly focused on care professionals and relatives, rather than the persons with SPMI themselves. This is reflected in the existing research that often had the voices of the latter missing. Future research may benefit from the inclusion of persons with SMPI’s first-hand accounts. End-of-life care for persons with SPMI may benefit from identifying and integrating (locally developed) good practices like cross-sectoral education, specific care models, and ethics support.
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Affiliation(s)
- Loïc Moureau
- Faculty of Theology and Religious Studies, KU Leuven, Leuven, Belgium
- *Correspondence: Loïc Moureau,
| | - Monica Verhofstadt
- Medical and Health Sciences, Ghent University, Ghent, East Flanders, Belgium
| | - Axel Liégeois
- Faculty of Theology and Religious Studies, KU Leuven, Leuven, Belgium
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Kasén A, Bondas T. “Suffering as a Lifelong Companion: A Phenomenological-Hermeneutic Study of Men Living With Severe Psychiatric Illness”Lidelse som livslang følgesvenn: En fenomenologisk-hermeneutisk studie av menn som lever med alvorlig psykiatrisk sykdom. Glob Qual Nurs Res 2022; 9:23333936211073616. [PMID: 35111888 PMCID: PMC8801648 DOI: 10.1177/23333936211073616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Accumulation of suffering in later life due to severe psychiatric illness has received surprisingly little interest in nursing research. Suffering in daily living seems to be more demanding for men, a phenomenon still debated in the literature. This phenomenological-hermeneutic study aims at describing and interpreting the perspectives of adult men and their experiences of suffering in daily living with severe psychiatric illness, diagnosed as schizophrenia. Data were collected in dialogical conversations with four men aged between 20 and 40 years, living alone in northern Norway. The themes created from the structural understanding illuminate the participants’ suffering as simultaneously struggling against the grasp of the illness and for reshaping the future. The theoretical interpretation unfolds the multidimensionality of their suffering and the need for confirmation of the suffering and reconciliation with the losses from illness, thus making reorientation to the future possible.
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Affiliation(s)
- Anne Kasén
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
- Faculty of Health Studies, VID, Specialized University, Bergen, Norway
| | - Terese Bondas
- Faculty of Health Sciences, University of Stavanger, Norway
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Koslander T, Rönning S, Magnusson S, Wiklund Gustin L. A 'near-life experience': lived experiences of spirituality from the perspective of people who have been subject to inpatient psychiatric care. Scand J Caring Sci 2020; 35:512-520. [PMID: 32329109 DOI: 10.1111/scs.12863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
AIMS To describe lived experiences of spirituality from the perspective of people who have been subject to inpatient psychiatric care and to interpret these experiences from an understanding of health as dialectical. METHODS After approval from a regional ethical board, eleven participants were recruited from two organisations for people with mental health problems. Participants were asked to narrate about spiritual experiences and occasions where such experiences had come close. The transcribed interviews were analysed by means of a phenomenological hermeneutical approach. FINDINGS A structural analysis of the text resulted in three themes; perceiving the presence of something extra mundane, making sense of reality and struggling for acceptance. The comprehensive understanding highlights spiritual experiences as going beyond religion, even though religious experiences appear as part of it. These experiences can indeed be a resource contributing to experiences of hope, connectedness, meaning and coherence in life. However, they can also give rise to doubt, anxiety and feelings of loneliness and hopelessness. Rather than understanding spiritual experiences as being either 'good' or 'bad', we could approach spirituality as something that is always present in alternate and inter-related forms. Metaphorically, this could be understood as a 'near-life experience', summarising participants' experiences related to their struggle with issues related to suffering and health which are simultaneously present. CONCLUSIONS If psychiatric nurses could approach this complexity and, without being judgemental, explore seemingly positive and negative experiences of spirituality as dialectically related to each other, rather than viewing them as either resources or problems, this could contribute to insiderness care and hopefully also support people who struggle with these experiences to seek help when needed.
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Affiliation(s)
- Tiburtius Koslander
- Integrierte Psychiatrie Winterthur - Zürcher Unterland, Winterthur, Switzerland
| | - Sonia Rönning
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Division of Psychiatry, County Council of Dalarna, Falun, Sweden
| | - Sofia Magnusson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Division of Psychiatry, County Council of Dalarna, Falun, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
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Zumstein N, Riese F. Defining Severe and Persistent Mental Illness-A Pragmatic Utility Concept Analysis. Front Psychiatry 2020; 11:648. [PMID: 32733295 PMCID: PMC7358610 DOI: 10.3389/fpsyt.2020.00648] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
The concept of severe and persistent mental illness (SPMI) lacks a consensual definition. Variations in definitions stem above all from different meanings about the constituent features of the concept and how to operationalize them. Our objective was to clarify the concept of SPMI and to explore the level of concept maturity through pragmatic utility (PU) concept analysis. Our findings suggest that SPMI is a partially mature concept that needs further clarification. We argue that the lack of a uniform definition is inherent to the problem: SPMI refers to a patient population rather than a disease entity, and the term has to be useful for different stakeholder purposes. Therefore, while an agreement on the principle three dimensions included in a definition may be possible (diagnosis, disability, and duration), their operationalization will have to be context-dependent and specific for the task at hand.
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Affiliation(s)
- Naomi Zumstein
- URPP "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Department of Anthropology, McGill University, Montréal, QC, Canada
| | - Florian Riese
- URPP "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Department of Geriatric Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
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Decorte I, Verfaillie F, Moureau L, Meynendonckx S, Van Ballaer K, De Geest I, Liégeois A. Oyster Care: An Innovative Palliative Approach towards SPMI Patients. Front Psychiatry 2020; 11:509. [PMID: 32581883 PMCID: PMC7294963 DOI: 10.3389/fpsyt.2020.00509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Oyster Care is the result of the search by caregivers in Flanders, Belgium, to develop quality care for patients with a Severe and Persistent Mental Illness (SPMI). This article offers a conceptual analysis of the Oyster Care model, based on experiences, analysis, and reflection of the authors, and on several examples. The starting point of the development of this new care model is the complex and difficult context of the care for SPMI patients. Their needs and suffering are very challenging on account of a wide variety of causes. At the same time they are in danger of being neglected by the care system. Paradoxically, the development and implementation of psychosocial rehabilitation in Belgian mental health care puts the care for these patients under pressure. In practice, they are often exposed to over- or under-treatment. Another aspect that has influenced the search for more qualitative care in cases of severe psychological suffering in general and palliative approaches in particular is the background of the legal regulation of euthanasia in Belgium. Oyster Care is an innovative form of the palliative approach and philosophy, tailored to the specific target group of SPMI patients. The caregivers create an "exoskeleton" or "shell" in which SPMI patients can "come to life": they are mainly dependent on the "external structure" they receive in order to function, rather than on the "internal structure" of their abilities. It is a dynamic approach that responds to the needs, possibilities and pace of each patient: within this safety, people can fold back or take new steps. Oyster Care is also a holistic care approach, based on four pillars: physical care adequately responding to the somatic impairments of these patients; psychological care changing the scope of therapy by focusing on mental comfort and wellbeing; social care providing a structure of daily activities and contacts; existential care enhancing the experience of life as valuable and meaningful. The wellbeing of patients is paramount and requires a range of interventions, such as a highly personal approach, a flexible dealing with rules, a great dose of creativity in everyday life, extensive expertise in somatic care, and specific attention to existential needs and the search for meaning. The development of this care model in a number of care units in Flanders increases the wellbeing of the patients and creates a significant positive dynamic among caregivers. However, more research and resources are needed to further develop and integrate this model.
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Affiliation(s)
| | | | - Loïc Moureau
- Gezondheidszorg Bermhertigheid Jesu, Brugge, Belgium
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Alburquerque-Sendín F, Ferrari AV, Rodrigues-de-Souza DP, Paras-Bravo P, Velarde-García JF, Palacios-Ceña D. The experience of being a psychiatric nurse in South Africa: A qualitative systematic review. Nurs Outlook 2018; 66:293-310. [PMID: 29573827 DOI: 10.1016/j.outlook.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the study was to summarize the experiences of African psychiatric nurses in their workplace by examining the findings of existing qualitative studies. METHODS Eleven studies published in English, Portuguese, and Spanish, between 1998 and 2016, which explored psychiatric nurses' experiences in Africa, were included. FINDINGS After meta-aggregation, five key findings were identified: 1) organization and management, 2) perceptions of professional safety and insecurity, 3) relationship with the patient, 4) emotional experiences and 5) recommendations for improvement. DISCUSSION The findings in this study highlight the stressful nature of the work climate of the psychiatric nurse in South Africa. More focus on improving working conditions and providing support is necessary to increase the quality of care for psychiatric mental health patients and their nurse providers.
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Affiliation(s)
| | | | | | | | - Juan Francisco Velarde-García
- Department of Nursing, Spanish Red Cross, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autonoma de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Comunidad de Madrid, Spain
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