Home and border: the contradictions of community

Dementia Without Borders: Building community connections to reduce stigma and foster inclusion

Around the world people with dementia face stigma and social exclusion. An interdisciplinary team from Seattle, Washington, and Vancouver, British Columbia led a collaborative project developing cross-border community partnerships to increase awareness and reduce stigma, promote social participation of people with dementia, and enhance their well-being. The work was organized around three themes - citizen engagement, social entrepreneurship, and creative expression - and involved regular meetings so researchers, community providers, and people with dementia and care partners could know each other better. Dementia Without Borders was organized as an end-of-project celebration, a public festival bringing together community members from both countries to share what the team had learned from each together. The event took place at the Peace Arch, an international park straddling the border between Washington and British Columbia. Over 140 people arrived on their respective sides, created banners, and walked together to the Peace Arch to meet and exchange gifts with those coming from the other country. A picnic shelter was used to display art created by people with dementia and outdoor tables allowed everyone to eat together and listen to poetry readings and musical performances. Feedback was overwhelmingly positive with many expressing a sense of hope and belonging. This project has leveraged the symbolic power of an international border to generate new ideas about fostering social inclusion and reducing stigma for people with dementia. It shows the importance of place and history, building relationships on trust and participation, and being flexible and responsive to opportunities for social innovation.

Centering and collaborating with community knowledge systems: piloting a novel participatory modeling approach

BACKGROUND

Systems science approaches like simulation modeling can offer an opportunity for community voice to shape policies. In the episteme of many communities there are elders, leaders, and researchers who are seen as bearers of historic knowledge and can contextualize and interpret contemporary research using knowledge systems of the community. There is a need for a systematic methodology to collaborate with community Knowledge Bearers and Knowledge Interpreters. In this paper we report the results of piloting a systematic methodology for collaborating with a community Knowledge-Bearer and Knowledge-Interpreter to develop a conceptual model revealing the local-level influences and architecture of systems shaping community realities. The use case for this pilot is 'persistent poverty' in the United States, specifically within the inner-city African American community in Baltimore City.

METHODS

This pilot of a participatory modeling approach was conducted over a span of 7 sessions and included the following steps, each with an associated script: Step 1: Knowledge-Bearer and Knowledge-Interpreter recruitment Step 2: Relationship building Step 3: Session introduction, Vignette development & enrichment Step 4: Vignette analysis & constructing architecture of systems map Step 5: Augmenting architecture of systems map RESULTS: Each step of the participatory modeling approach resulted in artifacts that were valuable for both the communities and the research effort. Vignette construction resulted in narratives representing a spectrum of lived experiences, trajectories, and outcomes within a community. The collaborative analysis of vignettes yielded the Architecture of Systemic Factors map, that revealed how factors inter-relate to form a system in which lived experience of poverty occurs. A literature search provided an opportunity for the community to contextualize existing research about them using realities of lived experience.

CONCLUSION

This methodology showed that a community Knowledge Bearer can function as communicators and interpreters of their community's knowledge base, can develop coherent narratives of lived experiences within which research and knowledge is contextualized, and can collaboratively construct conceptual mappings necessary for simulation modeling. This participatory modeling approach showed that even if there already exists a vast body of research about a community, collaborating with community gives context to that research and brings together disparate findings within narratives of lived experience.

"Life on hold": a qualitative study of patient experiences with outpatient commitment in two norwegian counties

In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients' experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients' daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.

Understanding the Journey Through Homelessness: A Hermeneutic Study of Women Without Children

This study explored the meaning of the experience of homelessness and exiting homelessness among women without children. Convenience and snowball sampling techniques were used to recruit 12 women in an urban centre in Canada. Texts resulting from audiotaped interviews, participant observations, and reflective journal entries constituted data for analysis. Gadamerian hermeneutics informed the interpretive method used for analysis. The analysis yielded 5 subthemes that described the journey: (a) loss of self at home: the trigger; (b) non-feeling of “at-homeness”: dissociation; (c) disconnection and aloneness: homelessness; (d) simulating home: transitional shelter living; and (e) finding oneself: hopefulness. Findings suggest that exiting homelessness for women was a journey in search of hope, and reconnection with the self and others. This perspective suggests a new approach for policy and practice.

In defence of a humanistic approach to mental health care: recovery processes investigated with the help of clients' narratives on turning points and processes of gradual change

Several studies in recent years have shown that recovery factors as experienced by clients are not always compatible with professional approaches. For example, clients often emphasize the importance of relationships and the satisfaction of universal human needs. The aim of the study has been to explore clients' descriptions of beneficial factors and to discuss the implications of those factors for the delivery of mental health services. Method has been qualitative content analysis of 347 user narratives. The study confirms findings in earlier recovery studies, but also demonstrates that the investigation of clients' stories leads to a range of existential dilemmas. Fundamental beliefs about what constitutes effective and necessary treatment are challenged. Recovery is a fundamentally personal process that involves finding a new sense of self and feeling of hope. Furthermore, it is not only an internal process; it also requires external conditions that facilitate a positive culture of healing.

Othering: difference understood??: a 10-year analysis and critique of the nursing literature

It has been 10 years since Advances in Nursing Science (ANS) published the first article that articulated othering within a nursing framework. This issue's topic, Critique and Replication, provided an opportunity for analysis of the influence of the original ANS article on the visibility and application of othering within nursing literature. Comprehensive searches of major health databases identified 32 publications citing the original ANS article. The analysis focused on exclusionary and inclusionary othering, role taking, and constructions of the other. Results indicate that although othering has become more visible within nursing literature, exclusionary othering dominates. The article concludes with thoughts for moving beyond othering and toward engagement.

Being and doing politics: an outdated model or 21st century reality?

AIM

This paper presents a discussion of how critical social theory can be used as a tool for research, reflection and exploration of the political role of the nurse.

BACKGROUND

Sociological theory can be used to examine ideologies within nursing systems in order to contribute to the future development of the profession. The importance of critical social theory has been identified in the literature as being directly relevant to holism which is central to the nature of nursing.

DATA SOURCES

Texts published in English were identified from 1990 to 2008 using the keywords critical social theory, community nursing, political advocacy, social justice, sociological theory, health inequalities, health democracy, equity and inequality.

DISCUSSION

Critical social theory can be used as a tool to highlight ethical ways to practise nursing. One reason for examination of the community nurse's political role is a shift in focus from the individual as patient to communities experiencing health inequalities. Nursing needs to decide whether the profession will work at the political level, and where advocacy and citizenship are located within a community role.

CONCLUSION

Nurse educators must prepare nurses for political participation, and nurse managers need to focus on national and local contexts in order to encourage policy analysis and community engagement within nursing practice. An understanding of critical social theory can aid decision-making in relation to global and local policy, enable the nursing profession to respond to social injustice, and permit nurses to work with communities in the pursuit of community health.

Protecting mental health clients' dignity - the importance of legal control

Protecting human beings' dignity is a fundamental value underlying the UN's Universal Declaration of Human Rights as well as several recommendations and conventions derived from this, among them the European Convention of Human Rights (ECHR), a declaration that also takes precedence over Norwegian legislation. Still, clients' stories inform us that their dignity is not always protected in the mental health service systems. The aim of the study has been to investigate violations of dignity considered from the clients' points of view, and to suggest actions that may ensure that practice is brought in line with human rights values. The method used has been a qualitative content analysis of 335 client narratives. The conclusion is that mental health clients experience infringements that cannot be explained without reference to their status as clients in a system which, based on judgments from medical experts, has a legitimate right to ignore clients' voices as well as their fundamental human rights. The main focus of this discussion is the role of the ECHR and the European Court of Human Rights as instruments for protecting mental health clients' human rights. To bring about changes, recommendations and practices should be harmonized with the new UN Convention on the Rights of Persons with Disabilities (2006). Under this convention, the European Court of Human Rights has support for the application of the ECHR without exemptions for special groups of people.

Developing community in care homes through a relationship-centred approach

Within the literature, the formation of therapeutic relationships between professionals, older people and others significant to them in their lives has been considered as central to current care philosophies. Furthermore, relationships between staff, residents and their families have emerged within the literature as fundamental to the experiences of life within the community of a care home. This paper reports part of a wider study that explored relationships between residents, families and staff. The aim of this paper is to contribute to an understanding of the factors that may be significant in the formation of relationships in care homes, and how this may support the development of community. Three case studies of care homes were undertaken using a constructivist approach. Constructivist methodology seeks to share multiple perceptions between participants with the aim of creating a joint construction. This process supported the development of shared meanings as views and ideas were shared between participants using interviews, participant observation and focus groups. The key factors influencing relationships that emerged were leadership, continuity of staff, personal philosophy of staff and contribution of residents and families. This paper suggests that considering how the style of leadership influences the organisation of care may be a useful starting point in developing community within care homes.

People with mental disabilities negotiating life in the risk society: a theoretical approach

Risk assessment and risk management owing to the potential threat from people with serious mental disorders living in the local community have been given much attention in psychiatric and mental healthcare research. Research connected to risks associated with living in the community for people with mental disabilities has also been published. This paper focuses on the situation of people with mental health problems and disabilities from a quite different perspective. In the light of the societal change towards what has been named the 'risk society', the consequences for vulnerable groups, especially people with mental disabilities, are discussed. Furthermore, the purpose is to shed light on how structural factors, like the process of individualization and 'de-population' of societal institutions, are affecting the living conditions for people with mental disabilities - positively as well as negatively. The importance of trust in the risk society is highlighted, but also the important role that the local community might play in relation to people with mental disabilities. Finally, some potentialities and new roles that this development towards a risk society and increased individualization paradoxically can open up for people with mental disabilities are outlined.

Exclusive inclusion: the violation of human rights and US immigration policy

In this article, we examine US immigration policies relative to those who work as nurses and those who are manual/low-wage laborers. Recruiting foreign nurses from developing countries to alleviate the nursing shortage is a common practice. While specialized visas for these healthcare professionals facilitate the visa application and approval process, immigrants employed in low-wage positions are subjected to long waits for visas, workplace raids, and subsequent deportation. Selective assistance to some immigrants violates basic human rights and global expectations of justice. Moral and ethical frameworks need to guide US immigration policy.

Knowledge about social networks and integration: a co-operative research project

AIM

This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice.

BACKGROUND

Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions.

METHOD

A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005.

FINDINGS

The main theme identified was the potential of experiential knowledge-based competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice.

CONCLUSION

Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer.

The struggle for social integration in the community--the experiences of people with mental health problems

The goal of social integration is part of the ideological motivation behind the transition from institutionalized to decentralized psychiatry. Modern community mental health care considers social integration as vital for improving mental health. However, reports suggest that efforts to socially integrate people who suffer from mental health problems have not been as successful as anticipated. The aim of this study was to explore how people with mental health problems experience their ability to integrate socially into a community in central Norway. Three multistage focus groups, consisting of 17 people with mental health problems, were set up in two counties of different sizes. In this explorative study, data were analysed using a qualitative content analysis method. The participants experienced shame and fear of exclusion in their struggle to become integrated in the community. They had a sense of loneliness, had to struggle for equality and experienced being neglected. The days passed very slowly and they reported a lack of financial resources. They wanted to work or take part in other daytime activities and sought reciprocal relationships. In conclusion, those working in community mental health care need to ensure that people suffering from mental health problems experience a sense of belonging in the community, thus enabling them to develop a network and achieve social integration.

Social capital and mental health: an interdisciplinary review of primary evidence

An interdisciplinary interrogation of primary evidence linking social capital and mental health sought to establish: (1) 'quality of evidence' (assessed in terms of study design, methods used to address stated questions, rigor of data analysis, and logic and clarity of interpretation of results), and (2) applicability of the evidence to public health policy and practice with respect to mental health. It is found that social capital, a complex and compound construct, can be both an asset and a liability with respect to mental health of those in receipt of and those providing services and other interventions. The most meaningful assessment of social capital or components thereof may examine individual access to rather than possession of social capital, a property of groups, and therefore an ecological variable. Theoretical advances in research on social capital serve to identify mainly two types of social capital: bonding (between individuals in a group) and bridging (between groups). Each type of social capital has cognitive and/or structural component(s) and may operate at micro and/or macro level(s). Effective mental health policy and service provision may build or strengthen bridging social capital and benefit from both bonding and bridging social capital where either or both exist. Established indicators of social capital are amenable to quantitative and qualitative assessment, preferably in tandem. However studies that employ combined research design are rare or non-existent. Interdisciplinary multi-method investigations and analyses are called for in order to unravel mechanisms whereby social capital and mental health might be meaningfully associated.