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Ferentinos P, Douki S, Yotsidi V, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Family in Crisis: Do Halfway Houses Perform Better Than Families with Expressed Emotion toward Patients with Schizophrenia? A Direct Adjusted Comparison. Healthcare (Basel) 2024; 12:375. [PMID: 38338260 PMCID: PMC10855104 DOI: 10.3390/healthcare12030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses' and 56 parents' EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2-5 nurses and each outpatient by 1-2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients' age, negative symptoms, and perceived criticism and caregivers' age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Stamatina Douki
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University of Social and Political Sciences, 176 71 Athens, Greece;
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, 15 451 Athens, Greece;
| | - Dimitra Dragoumi
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
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Ferentinos P, Douki S, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Differential correlates of criticism versus emotional overinvolvement towards patients with schizophrenia living in halfway houses or with their families. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02609-7. [PMID: 38296844 DOI: 10.1007/s00127-023-02609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/22/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE This study systematically searched for differential correlates of criticism vs. emotional overinvolvement (EOI) towards patients with schizophrenia in families and halfway houses, which have only incidentally been reported in previous research. Identified patterns were compared across settings. METHODS We included 40 inpatients with schizophrenia living in halfway houses and 40 outpatients living with their families and recorded the expressed emotion (EE) of 22 psychiatric nurses or 56 parents, respectively, through Five Minutes Speech Samples. Each nurse rated 1-12 inpatients and each inpatient was rated by 2-5 nurses. Each outpatient was rated by one or both parents. As EE ratings had a multilevel structure, weighted Spearman correlations of criticism and EOI with various patient- and caregiver-related characteristics were calculated and compared with Meng's z-test. RESULTS Criticism was weakly negatively correlated with EOI in nurses but negligibly in parents. Distinct patterns of significant differential correlates arose across settings. Outpatients' aggressive behavior and parents' related burden were mainly associated with higher criticism. Inpatients' symptoms (agitation/aggression, negative and other psychotic symptoms) and nurses' burnout (Depersonalization) were mainly associated with lower EOI. Inpatients' perceived criticism and outpatients' previous suicide attempts were equally associated with higher criticism and lower EOI (mirror correlations). Finally, various inpatient attributes (older age, chronicity, unemployment and smoking) triggered higher EOI only. Inpatients' age, psychopathology (esp. agitation/aggression and negative symptoms) and perceived criticism survived adjustment for multiple comparisons. CONCLUSION Our findings suggest setting-specific pathogenetic pathways of criticism and EOI and might help customize psychoeducational interventions to staff and families.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
| | - Stamatina Douki
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Dimitra Dragoumi
- Department of Psychiatry, "Evangelismos" General Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Athanassios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
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da Silva AHS, de Souza Tressoldi L, de Azevedo-Marques JM, Shuhama R, Del-Ben CM, Galera SAF, da Silva Gherardi-Donato EC, Vedana KGG, Zanetti ACG. Predictors of Expressed Emotion in First Episode Psychosis. Issues Ment Health Nurs 2020; 41:908-915. [PMID: 32568611 DOI: 10.1080/01612840.2020.1749916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses.
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Affiliation(s)
- Amanda Heloisa Santana da Silva
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Rosana Shuhama
- Psychiatry Division. Department of Neurosciences and Behavior, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Psychiatry Division. Department of Neurosciences and Behavior, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sueli Aparecida Frari Galera
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Edilaine Cristina da Silva Gherardi-Donato
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Kelly Graziani Giacchero Vedana
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing. World Health Organization (WHO), Collaborating Centre for Nursing Research Development, Ribeirão Preto, São Paulo, Brazil
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Abstract
SummaryOver the past decade attention to the provision of healthcare for individuals with personality disorder, particularly those who pose a risk to others, has substantially increased. Keeping pace with such developments with a suitably trained, consistent and motivated workforce, interfacing health and criminal justice systems where necessary, presents an enormous challenge. Staff must be experts in managing conflict at every level, while sustaining an optimistic and therapeutic orientation. Boundaried relationships provide the context for recovery for patients. Key principles and practices likely to promote resilience in personality disorder services, with a focus on the role of supervision, are outlined in order to support staff in keeping themselves afloat, their patients safe, and their services on target.
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Abstract
Family therapy for schizophrenia began in the early 1950s, inspired by theories that located the cause of the illness in family dysfunction. The family pathology was seen as stemming from disturbed relationships (Fromm-Reichmann, 1948; Lidz et al, 1956; Laing & Esterson, 1964) and / or distorted communication (Bateson et al, 1956; Wynne & Singer, 1963).
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Rienecke RD, Sim L, Lock J, Le Grange D. Patterns of expressed emotion in adolescent eating disorders. J Child Psychol Psychiatry 2016; 57:1407-1413. [PMID: 27377705 PMCID: PMC5115973 DOI: 10.1111/jcpp.12594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND This goal of this study was to understand the patterns of expressed emotions (EEs) in adolescent eating disorders. As such, this study compared EE among families of adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and a psychiatric control group, major depressive disorder (MDD). This study also examined the influence of family status (intact vs. nonintact) and the presence of siblings on EE. METHODS Two-hundred and fifteen adolescents (ages 12-19) and their families were recruited for this study including 121 adolescents with AN, 54 adolescents with BN, and 40 adolescents with MDD. Adolescents with at least one parent completed the Standardized Clinical Family Interview. Adolescents completed structured diagnostic interviews to assess eligibility for the study, as well as a standardized questionnaire to assess depression. RESULTS Analyses revealed that fathers showed higher levels of critical comments to adolescents with BN or MDD than those with AN, whereas mothers made more critical comments toward patients with BN. Mothers made the least number of positive remarks toward patients with MDD. In terms of the influence of family status, fathers from intact families showed more expressions of warmth and were less critical than fathers from nonintact families, whereas mothers from intact families were less critical but also made fewer positive remarks than mothers from nonintact families. The presence of siblings appeared to reduce mothers' expression of warmth and emotional overinvolvement. CONCLUSIONS Unique patterns of EE were found to characterize AN, BN, and MDD. Family status and the presence of siblings exert an influence on EE that should be taken into consideration in future research.
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Affiliation(s)
- Renee D. Rienecke
- Department of Pediatrics at Medical University of South Carolina, Charleston, SC,Department of Psychiatry at the University of Michigan, Ann Arbor, MI
| | - Leslie Sim
- Department of Psychiatry and Psychology at the Mayo Clinic, Rochester, MN
| | - James Lock
- Department of Psychiatry & Behavioral Sciences at Stanford University, Stanford, CA
| | - Daniel Le Grange
- Department of Psychiatry at the University of California, San Francisco, San Francisco, CA, USA
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Rienecke RD, Lebow J, Lock J, Le Grange D. Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:428-436. [PMID: 25945418 DOI: 10.1080/15374416.2015.1030755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.
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Affiliation(s)
| | - Jocelyn Lebow
- b Department of Psychiatry & Behavioral Sciences , University of Miami.,c Department of Psychiatry and Psychology , Mayo Clinic
| | - James Lock
- d Department of Psychiatry & Behavioral Sciences , Stanford University
| | - Daniel Le Grange
- e Department of Psychiatry , University of California , San Francisco
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Hoste RR, Lebow J, Le Grange D. A bidirectional examination of expressed emotion among families of adolescents with bulimia nervosa. Int J Eat Disord 2015; 48:249-52. [PMID: 24888496 PMCID: PMC4783131 DOI: 10.1002/eat.22306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this paper was to examine expressed emotion (EE) measured from adolescents with bulimia nervosa (BN) toward their parents, in addition to measuring EE from parents toward patients. METHOD Fifty-four adolescents and their parents who were receiving treatment for BN participated in a videotaped family interview, from which ratings of EE were made. RESULTS Parent and patient scores were highly correlated. Four family profiles were created (Low Patient EE/Low Parent EE; High Patient EE/High Parent EE; Low Patient EE/High Parent EE; High Patient EE/Low Parent EE) to determine whether the match between parent and patient EE was related to treatment outcome. The Low Patient EE/Low Parent EE group demonstrated the greatest reduction in purging from baseline to end-of-treatment; the High Patient EE/Low Parent EE group showed the smallest reduction in purging. DISCUSSION EE has historically been rated from relatives toward patients, but patients' own EE may also be related to treatment outcome.
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Affiliation(s)
- Renee Rienecke Hoste
- Assistant Professor, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jocelyn Lebow
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL
| | - Daniel Le Grange
- Professor, Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL
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Cechnicki A, Bielańska A, Hanuszkiewicz I, Daren A. The predictive validity of expressed emotions (EE) in schizophrenia. A 20-year prospective study. J Psychiatr Res 2013; 47:208-14. [PMID: 23158233 DOI: 10.1016/j.jpsychires.2012.10.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/10/2012] [Accepted: 10/12/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The level of expressed emotions in the family (EE) and components thereof (emotional over-involvement EOI, and critical comments CC) have been found to be related to treatment outcomes in psychotic patients. One point of interest is the dynamic of various outcomes in relation to initial EE, CC and EOI levels. METHOD 43 individuals with diagnosis of schizophrenia were assessed at 1, 3, 7, 12 and 20-year follow-ups. The EE indicator was evaluated during the index hospitalization. Outcome indicators included: number of relapses, number and duration of in-patient rehospitalizations, and severity of psychopathological symptoms. RESULTS 1) A high EE indicator was associated with a higher number of relapses in every follow-up and differences between the groups with low and high EE indicators proved significant after 3, 7, 12 and 20 years of the illness. 2) A high EE indicator was associated with a higher number of rehospitalizations after 3 and 7 years, and showed as a clear trend after 12 and 20 years. 3) A high level of CC was associated with a higher number of relapses. 4) The severity of positive symptoms increased only in the group with high CC. 5) The negative syndrome was not associated with EE, EOI or CC. CONCLUSIONS The EE indicator may be considered a valid prolonged predictor of relapses and rehospitalizations. A high level of CC was associated with a higher number of relapses and intensification of the positive syndrome in both the short-term and long-term course of the illness.
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Affiliation(s)
- Andrzej Cechnicki
- Community Psychiatry Unit, Chair of Psychiatry, Collegium Medicum, Jagiellonian University, 2/8 Sikorskiego sq., 31-115 Cracow, Poland.
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Dwamena F, Holmes‐Rovner M, Gaulden CM, Jorgenson S, Sadigh G, Sikorskii A, Lewin S, Smith RC, Coffey J, Olomu A, Beasley M. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev 2012; 12:CD003267. [PMID: 23235595 PMCID: PMC9947219 DOI: 10.1002/14651858.cd003267.pub2] [Citation(s) in RCA: 342] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Communication problems in health care may arise as a result of healthcare providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care delivery in the patient encounter are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. However, the impact of these interventions directly on clinical encounters and indirectly on patient satisfaction, healthcare behaviour and health status has not been adequately evaluated. OBJECTIVES To assess the effects of interventions for healthcare providers that aim to promote patient-centred care (PCC) approaches in clinical consultations. SEARCH METHODS For this update, we searched: MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), and CINAHL (EbscoHOST) from January 2000 to June 2010. The earlier version of this review searched MEDLINE (1966 to December 1999), EMBASE (1985 to December 1999), PsycLIT (1987 to December 1999), CINAHL (1982 to December 1999) and HEALTH STAR (1975 to December 1999). We searched the bibliographies of studies assessed for inclusion and contacted study authors to identify other relevant studies. Any study authors who were contacted for further information on their studies were also asked if they were aware of any other published or ongoing studies that would meet our inclusion criteria. SELECTION CRITERIA In the original review, study designs included randomized controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions for healthcare providers that promote patient-centred care in clinical consultations. In the present update, we were able to limit the studies to randomized controlled trials, thus limiting the likelihood of sampling error. This is especially important because the providers who volunteer for studies of PCC methods are likely to be different from the general population of providers. Patient-centred care was defined as a philosophy of care that encourages: (a) shared control of the consultation, decisions about interventions or management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole person who has individual preferences situated within social contexts (in contrast to a focus in the consultation on a body part or disease). Within our definition, shared treatment decision-making was a sufficient indicator of PCC. The participants were healthcare providers, including those in training. DATA COLLECTION AND ANALYSIS We classified interventions by whether they focused only on training providers or on training providers and patients, with and without condition-specific educational materials. We grouped outcome data from the studies to evaluate both direct effects on patient encounters (consultation process variables) and effects on patient outcomes (satisfaction, healthcare behaviour change, health status). We pooled results of RCTs using standardized mean difference (SMD) and relative risks (RR) applying a fixed-effect model. MAIN RESULTS Forty-three randomized trials met the inclusion criteria, of which 29 are new in this update. In most of the studies, training interventions were directed at primary care physicians (general practitioners, internists, paediatricians or family doctors) or nurses practising in community or hospital outpatient settings. Some studies trained specialists. Patients were predominantly adults with general medical problems, though two studies included children with asthma. Descriptive and pooled analyses showed generally positive effects on consultation processes on a range of measures relating to clarifying patients' concerns and beliefs; communicating about treatment options; levels of empathy; and patients' perception of providers' attentiveness to them and their concerns as well as their diseases. A new finding for this update is that short-term training (less than 10 hours) is as successful as longer training.The analyses showed mixed results on satisfaction, behaviour and health status. Studies using complex interventions that focused on providers and patients with condition-specific materials generally showed benefit in health behaviour and satisfaction, as well as consultation processes, with mixed effects on health status. Pooled analysis of the fewer than half of included studies with adequate data suggests moderate beneficial effects from interventions on the consultation process; and mixed effects on behaviour and patient satisfaction, with small positive effects on health status. Risk of bias varied across studies. Studies that focused only on provider behaviour frequently did not collect data on patient outcomes, limiting the conclusions that can be drawn about the relative effect of intervention focus on providers compared with providers and patients. AUTHORS' CONCLUSIONS Interventions to promote patient-centred care within clinical consultations are effective across studies in transferring patient-centred skills to providers. However the effects on patient satisfaction, health behaviour and health status are mixed. There is some indication that complex interventions directed at providers and patients that include condition-specific educational materials have beneficial effects on health behaviour and health status, outcomes not assessed in studies reviewed previously. The latter conclusion is tentative at this time and requires more data. The heterogeneity of outcomes, and the use of single item consultation and health behaviour measures limit the strength of the conclusions.
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Affiliation(s)
- Francesca Dwamena
- Michigan State University College of Human MedicineDepartment of MedicineB331 Clinical CenterEast LansingMichiganUSA48824‐1316
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Carolyn M Gaulden
- Michigan State University College of Human MedicineDepartment of MedicineB331 Clinical CenterEast LansingMichiganUSA48824‐1316
| | - Sarah Jorgenson
- Michigan State UniversityDepartment of Bioethics, Humanities and SocietyEast LansingMIUSA
| | - Gelareh Sadigh
- University of Michigan Medical Center1500 E. Medical Center DriveTaubman Center B1 132KAnn ArborMichiganUSA48109‐5302
| | - Alla Sikorskii
- Michigan State UniversityDepartment of Statistics and ProbabilityA423 Wells HallEast LansingMichiganUSA48824
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health ServicesGlobal Health UnitBox 7004 St OlavsplassOsloNorwayN‐0130
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Robert C Smith
- Michigan State University College of Human MedicineDepartment of MedicineB331 Clinical CenterEast LansingMichiganUSA48824‐1316
| | - John Coffey
- Michigan State UniversityMain Library100 LibraryEast LansingMichiganUSA48824‐1048
| | - Adesuwa Olomu
- Michigan State University College of Human MedicineDepartment of MedicineB331 Clinical CenterEast LansingMichiganUSA48824‐1316
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Zanetti ACG, Wiedemann G, Dantas RAS, Hayashida M, de Azevedo-Marques JM, Galera SAF. Cultural adaptation and psychometric properties of the family questionnaire in a Brazilian sample of relatives of schizophrenia outpatients. J Clin Nurs 2012; 22:1521-30. [DOI: 10.1111/j.1365-2702.2012.04351.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Ana CG Zanetti
- University of São Paulo at Ribeirão Preto College of Nursing; World Health Organization (WHO); Collaborating Centre for Nursing Research Development; Ribeirão Preto; Brazil
| | - Georg Wiedemann
- Department of Psychiatry and Psychotherapy; University of Tubingen; Tubingen; Germany
| | - Rosana AS Dantas
- University of São Paulo at Ribeirão Preto College of Nursing; World Health Organization (WHO); Collaborating Centre for Nursing Research Development; Ribeirão Preto; Brazil
| | - Miyeko Hayashida
- University of São Paulo at Ribeirão Preto College of Nursing; World Health Organization (WHO); Collaborating Centre for Nursing Research Development; Ribeirão Preto; Brazil
| | - João M de Azevedo-Marques
- Faculty of Medicine of Ribeirão Preto; University Hospital, University of São Paulo; Ribeirão Preto; Brazil
| | - Sueli AF Galera
- University of São Paulo at Ribeirão Preto College of Nursing; World Health Organization (WHO); Collaborating Centre for Nursing Research Development; Ribeirão Preto; Brazil
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Galera SAF, Zanetti ACG, Ferreira GCDS, Giacon BCC, Cardoso L. [Research with families of people with mental disorder]. Rev Bras Enferm 2012; 64:774-8. [PMID: 22378527 DOI: 10.1590/s0034-71672011000400022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 10/25/2010] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper is to present a critical reflection on the knowledge produced on the topics: the impact of the mental illness in the family, the impact of the family environment in the evolution of the eating and the experience family with the mental illness. The measures of overload and express emotion are useful to guide public politics and the practice professional, however in they do not give a multidimensional picture to them of the experience of the care. Research on the familiar experience contribute to the understanding of the present suffering in this experience and of the forms of confrontation adopted by the families, also contributing to perceive the differences of the cultural contexts in the confrontation of the families.
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Affiliation(s)
- Sueli Aparecida Frari Galera
- Departamento de Enfermagem Psiquiátrica e Ciências Humanas, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
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Magliano L, Fiorillo A, Malangone C, De Rosa C, Favata G, Sasso A, Prezioso M, Pezzenati L, Gentile F, Casale L, Bondi E, Test GR, Di Lella M, Biscussi E, Degl'Innocenti F, Bellini R, Di Nunzio R, Matrella L, Salmeri R, Cantone R, Gargiulo L, Esposito A, Delcuratolo V, Giannini M, Maresca L, Cavaliere G, Scandone B, Folla M, Raffaeli M, Innocente P, Dagianti F, Lucania S, Scorsino A, Bardicchia F, Cerullo G, Curreli R, Miscali S, Scordato M, Campo G, Mameli C, Sodde C, D'Ambra L, Malacarne A, Maj M. Benefits and difficulties in implementing family psychoeducational interventions for schizophrenia in mental health services: results from a multicentre Italian study. Epidemiol Psychiatr Sci 2011; 14:235-42. [PMID: 16396431 DOI: 10.1017/s1121189x00007983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYAims – This study aims to explore: a) the feasibility of psycho-educational interventions for families of users with schizophrenia in clinical practice by trained staff; b) the benefits and problems encountered by professionals in the use of these interventions. Methods – 46 professionals from 23 Italian Mental Health Sen'ices (MHS) attended at a three-module training course in psycho-educational interventions and four supervisions in the subsequent year. Following the course, participants provided the intervention to families of users with schizophrenia. The difficulties and benefits encountered by trainees to use the intervention were registered on the Family Intervention Schedule.Results – 83% of the participants completed the training course. Following the course, the intervention started in 71 families from 17 MHS. 76% of trainees provided the intervention to 2-5 families, while 13% of them only held informative sessions on schizophrenia. During the supervision period, the organisational difficulties experienced by the professionals were stable, while the benefits increased. Differences in benefits and difficulties were detected in relation to the trainees’ experience and professional roles. Conclusions – It is possible to introduce psycho-educational interventions in MHS after a relatively brief period of training and supervision of the staff. Organisational difficulties need to be addressed to increase the dissemination of these interventions on a large scale.Declaration of Interest: None of the authors has had any interest or he/she has received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work. None of the authors has received any form of fee for his/her participation in this study. This study was supported by grants received from the “M. Lugli” Foundation (grant n. 2/18/8) and from the National Institute of Health, Italy (grant no. 1AL/F3).
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Van Humbeeck G, Van Audenhove C. Expressed emotion of professionals towards mental health patients. Epidemiol Psychiatr Sci 2011; 12:232-7. [PMID: 14968481 DOI: 10.1017/s1121189x00003043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Smith IC. A qualitative investigation into the effects of brief training in solution-focused therapy in a social work team. Psychol Psychother 2011; 84:335-48. [PMID: 22903873 DOI: 10.1111/j.2044-8341.2010.02000.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Previous research into the effectiveness of brief training in psychological therapies for non-therapist health and social services workers has found mixed results regarding transferring learning into practice. Very few published studies have assessed the impact of such training in Solution-Focused Brief Therapy (SFBT), despite such training being popular. This study explored the impact of brief SFBT training for a group of community-based social workers. DESIGN A qualitative interview-based design was used, with the researcher adopting an ethnographic stance to obtain a rich, detailed and focused account of events. METHODS Six social workers working with adults with intellectual disabilities took part in the study. All had attended a 2-day workshop in SFBT 9 months previously. The interviews were transcribed and subjected to thematic analysis. RESULTS AND CONCLUSIONS Factors affecting skill transfer included being able to practise, peer and organizational support, and perceived conflicts between SFBT and work role. Whilst specific trained techniques were not consistently adopted, most workers changed the style of their interaction with clients in simple ways which they reported resulted in benefits including improved communication, collaboration, and increased feelings of control and self-efficacy for clients and workers. The findings suggest that in addition to peer and organizational support, trainees' perceptions of the fit of the training with their work role may be a key factor in determining transfer. Recommendations are made for developing training for non-therapists that focuses on helping change the style of their interactions rather than on learning to implement specific psychological therapy techniques.
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Berry K, Barrowclough C, Haddock G. The role of expressed emotion in relationships between psychiatric staff and people with a diagnosis of psychosis: a review of the literature. Schizophr Bull 2011; 37:958-72. [PMID: 20056685 PMCID: PMC3160217 DOI: 10.1093/schbul/sbp162] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The concept of expressed emotion (EE) has been extended to the study of staff-patient relationships in schizophrenia. A comprehensive review of the literature identified a total of 27 studies investigating EE in this group published between 1990 and 2008. The article aims to assess whether the concept of EE is a useful and valid measure of the quality of professional caregiver and patient relationships, given that staff may be less emotionally invested in relationships than relatives. In doing so, it summarizes methods of measuring EE, the nature of professional EE compared with familial EE, associations between high EE and patient outcomes, associations between EE and both patient and staff variables, and intervention studies to reduce staff high EE. The available evidence suggests that the Camberwell Family Interview is an acceptable measure of EE in staff-patient relationships, although the Five Minute Speech Sample may provide a less resource intensive alternative. However, in contrast to familial research, neither the EE status on the Camberwell Family Interview nor the Five Minute Speech Sample show a robust relationship with outcomes. The presence or absence of a positive staff-patient relationship may have more predictive validity in this group. There is relatively consistent evidence of associations between staff criticism and poorer patient social functioning. Consistent with findings in familial research, staff attributions may play a key role in driving critical responses, and it may be possible to reduce staff high EE by modifying negative appraisals.
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Affiliation(s)
- Katherine Berry
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | | | - Gillian Haddock
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, UK
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Endley L, Berry K. Increasing awareness of expressed emotion in schizophrenia: an evaluation of a staff training session. J Psychiatr Ment Health Nurs 2011; 18:277-80. [PMID: 21395920 DOI: 10.1111/j.1365-2850.2010.01683.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L Endley
- Clinical Lead, Turning Point, Birchwood, Oldham, UK
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Smith IC. Assessing Trainee Clinical Psychologists' Clinical Competence: A Commentary. PSYCHOLOGY LEARNING AND TEACHING-PLAT 2010. [DOI: 10.2304/plat.2010.9.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Solomon P, Alexander L, Uhl S. The relationship of case managers' expressed emotion to clients' outcomes. Soc Psychiatry Psychiatr Epidemiol 2010; 45:165-74. [PMID: 19370297 DOI: 10.1007/s00127-009-0051-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 03/27/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Expressed emotion (EE) has been studied in families of a relative with schizophrenia as well as other psychiatric disorders; and high EE (hostile, critical, and overinvolved) families have been found to be strongly related to relapse among their relatives. EE has been assessed on a limited basis among non-familial care providers and determined that providers can also have high EE which results in poor quality of life and negative consequences for their clients. METHODS The present study assessed 42 case managers serving clients with schizophrenia spectrum disorder regarding their EE for specific clients enrolled in a larger study examining the reliability and validity of two alliance measures. Case managers and clients were personally interviewed at baseline, 3, 6, 6 plus 2 weeks, and 9 months post-client entry into case management. The EE measure was inserted into the 6 months plus 2 week case manager interview. Generalized Estimating Equation analysis was employed to examine predicted outcomes of EE. RESULTS High EE was found to be related to client attitudes toward medication compliance and social contact. CONCLUSIONS Family psychoeducation interventions, an evidence-based practice, have been demonstrated to be effective in reducing relapse of relatives with serious mental illness. Given the clinical evidence that EE is modifiable, it is expected that such educational training for non-familial caregivers will have the same potential as for family caregivers. Providers dealing with challenging clients may also need support and skills to better handle difficult situations, especially direct support providers like case managers who are not clinically trained.
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Affiliation(s)
- Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, USA.
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Hewitt J. Redressing the balance in mental health nursing education: arguments for a values-based approach. Int J Ment Health Nurs 2009; 18:368-79. [PMID: 19740146 DOI: 10.1111/j.1447-0349.2009.00633.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Evidence-based practice (EBP) has become a dominant epistemology in nursing education, and has devalued the complex interpersonal components of mental health nursing. A curriculum for mental health nursing, which values the personhood of service users, should focus on those processes that promote recovery within a therapeutic relationship committed to collaboration and respect for diversity. These relationships become possible where the preparation of mental health nurses for practice includes an examination of self in terms of beliefs and values and their consequences on others. The combination of action and reflection in praxis provides a means by which self-examination and professional obligation can be examined in order to construct a moral identity, which is responsive to the needs of people with mental health problems. Praxis is more than a means of reflecting on practice: it draws together skill, practice knowledge, attitudinal style, and moral reasoning. For this reason, ethical values have a vital role to play in the development of contemporary nursing praxis.
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Affiliation(s)
- Jeanette Hewitt
- Centre for Philosophy, Swansea University, Swansea, South Wales, UK.
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van Meijel B, Megens Y, Koekkoek B, de Vogel W, Kruitwagen C, Grypdonck M. Effective interaction with patients with schizophrenia: qualitative evaluation of the interaction skills training programme. Perspect Psychiatr Care 2009; 45:254-61. [PMID: 19780998 DOI: 10.1111/j.1744-6163.2009.00228.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE. The purpose of this study was to describe experiences of caregivers with the Interaction Skills Training Programme, and to evaluate the training effects observed by caregivers. DESIGN AND METHODS. A qualitative research design was applied. Semistructured interviews were conducted with 17 caregivers who had followed the training program. FINDINGS. The research findings clearly confirm the value of the program. Positive effects of the training were reported in terms of: (a) awareness and insightfulness; (b) the attitude of caregivers; (c) the quality of the therapeutic alliance; and (d) job perception. PRACTICE IMPLICATIONS. Training interactive skills may contribute to a better quality of care for chronic psychiatric patients. Based on the qualitative study, implementation of the skills training program can be recommended.
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Affiliation(s)
- Berno van Meijel
- INHolland University for Applied Sciences, Research Group Mental Health Nursing, Amsterdam, the Netherlands.
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A Pilot Study Investigating the Use of Psychological Formulations to Modify Psychiatric Staff Perceptions of Service Users with Psychosis. Behav Cogn Psychother 2008; 37:39-48. [DOI: 10.1017/s1352465808005018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Whitehurst T. Impact of Mental Health Training for Frontline Staff Working With Children With Severe Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2008. [DOI: 10.1111/j.1741-1130.2007.00133.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The Thorn Course that provides psychosocial interventions and family work training for UK mental health professionals was founded in 1992. Since this time policy, service provision and needs have changed. The aim of this study was to examine the Thorn Course through relevant literature, in order to establish whether research and policy have been integrated into practice within training and services. A search of professional journal databases was conducted. Keywords used were 'Thorn Course' and 'psychosocial intervention training'. The resulting body of literature was reviewed. Five main themes emerged which were examined: needs identified, delivering the Thorn Course, training outcomes, implementing interventions and user and carer involvement. There is a distinct lack of research studies evaluating any aspect of the Thorn Course. There is little evidence that user and carer involvement has moved beyond rhetoric and community mental health nurses continue to lack opportunities and support to implement psychosocial skills acquired in training.
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Affiliation(s)
- A Couldwell
- Nottinghamshire Healthcare NHS Trust, Nottinghamshire, UK
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Stanhope V, Solomon P. Bridging the gap: using microsociological theory to understand how expressed emotion predicts clinical outcomes. Psychiatr Q 2007; 78:117-28. [PMID: 17333394 DOI: 10.1007/s11126-006-9032-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Research has shown that expressed emotion (EE) among families is a strong predictor of relapse for people with severe mental illness. Recent studies have also found the presence of EE in consumer-provider relationships. Despite high consistency in the findings related to EE and relapse, the concept has weak validity as little is known about how exactly it triggers relapse. Microsociological theory provides a framework with which to analyze social interaction and, more specifically, understand how interactions relate to the emotions of pride and shame. By identifying the components of interaction rituals, the theory provides insight into the key processes underlying EE and demonstrates how methodologies based on direct observation have the potential to measure EE with greater validity. This article describes how microsociological theory can be applied to the concept of EE.
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Affiliation(s)
- Victoria Stanhope
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214, USA.
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Berry K. Psychology services in psychiatric rehabilitation: Service user needs and staff perceptions. Clin Psychol Psychother 2007. [DOI: 10.1002/cpp.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Szmidla A, Leff J. Differentiating the effects of pharmacological and psychosocial interventions in an intensive rehabilitation programme. Soc Psychiatry Psychiatr Epidemiol 2006; 41:734-7. [PMID: 16862392 DOI: 10.1007/s00127-006-0072-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is of clinical importance to identify the contribution of the individual components in a composite intervention, but this is difficult in practice. The aim of this study was to differentiate the effects of pharmacological and psychosocial interventions in improving the symptoms of patients with schizophrenia undergoing an intensive rehabilitation programme. METHOD The Krawiecka Goldberg Vaughn scale was used to record the symptoms of 19 long-stay inpatients in the rehabilitation programme. Ratings were made every 2 weeks for periods of between 1 year and 20 months. RESULTS Analysis of the time course of symptoms showed that substitution of a single novel antipsychotic for conventional antipsychotic regimes was followed by a significant reduction in delusions but no improvement in hallucinations or negative symptoms. However, hallucinations and negative symptoms reduced significantly over the whole period of the observations, indicating an effect of the composite psychosocial interventions in the programme. CONCLUSIONS For patients with persistent psychotic symptoms, changing from conventional to novel antipsychotic medication is likely to reduce delusions, whereas hallucinations and negative symptoms may be more responsive to a combination of psychosocial interventions.
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Affiliation(s)
- Andrew Szmidla
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK.
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Van Humbeeck G, Van Audenhove C, Storms G, De Hert M, Pieters G, Vertommen H, Peuskens J, Heyrman J. Expressed Emotion in the Client-Professional Dyad. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2004. [DOI: 10.1027/1015-5759.20.4.237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Summary: Background: This article reports on a study of the concurrent validity between the standard expressed emotion instrument, the Camberwell Family Interview (CFI), and two alternative EE measures, the Level of Expressed Emotion (LEE) and the Perceived Criticism Scale (PCS). Methods: The research sample consisted of 56 schizophrenic clients, who were residing in sheltered residences, and 56 professionals. Results: Based on the results of the correlation matrix between all the subscales of the instruments, a significantly positive relationship was found between the criticism scale of the CFI, the total score of the LEE, and the client version of the PCS. These correlations, however, were rather weak, which implies that the three instruments have little in common with each other. The professionals' version of the PCS does not appear to be an EE instrument. Conclusions: The results suggest that the CFI still remains the best instrument for assessing EE in a therapeutic relationship (between a professional and a client). If there is insufficient time to administer the CFI, then the client version of the PCS and the LEE can be used with the qualification that the PCS and LEE also measure other aspects and thus cannot completely replace the CFI. Nevertheless, the research indicates that asking the clients would seem to provide a better indication of the level of the professionals' criticism rather than asking the professionals themselves directly.
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Affiliation(s)
- G. Van Humbeeck
- Department of Psychology, Katholieke Universiteit Leuven, Belgium
- LUCAS, Katholicke Universiteit Leuven, Belgium
| | - Ch. Van Audenhove
- Department of Psychology, Katholieke Universiteit Leuven, Belgium
- LUCAS, Katholicke Universiteit Leuven, Belgium
- Department of Medicine, Katholieke Universiteit Leuven, Belgium
| | - G. Storms
- Department of Psychology, Katholieke Universiteit Leuven, Belgium
| | - M. De Hert
- Department of Public Health, Division of Psychosocial Factors and Health, UC St. Jozef Kortenberg, Belgium
| | - G. Pieters
- Department of Medicine, Katholieke Universiteit Leuven, Belgium
- Department of Public Health, Division of Psychosocial Factors and Health, UC St. Jozef Kortenberg, Belgium
| | - H. Vertommen
- Department of Psychology, Katholieke Universiteit Leuven, Belgium
| | - J. Peuskens
- Department of Medicine, Katholieke Universiteit Leuven, Belgium
- Department of Public Health, Division of Psychosocial Factors and Health, UC St. Jozef Kortenberg, Belgium
| | - J. Heyrman
- Department of Medicine, Katholieke Universiteit Leuven, Belgium
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Williamson GR. Misrepresenting random sampling? A systematic review of research papers in the Journal of Advanced Nursing. J Adv Nurs 2003; 44:278-88. [PMID: 14641398 DOI: 10.1046/j.1365-2648.2003.02803.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM This paper discusses the theoretical limitations of the use of random sampling and probability theory in the production of a significance level (or P-value) in nursing research. Potential alternatives, in the form of randomization tests, are proposed. BACKGROUND Research papers in nursing, medicine and psychology frequently misrepresent their statistical findings, as the P-values reported assume random sampling. In this systematic review of studies published between January 1995 and June 2002 in the Journal of Advanced Nursing, 89 (68%) studies broke this assumption because they used convenience samples or entire populations. As a result, some of the findings may be questionable. DISCUSSION The key ideas of random sampling and probability theory for statistical testing (for generating a P-value) are outlined. The result of a systematic review of research papers published in the Journal of Advanced Nursing is then presented, showing how frequently random sampling appears to have been misrepresented. Useful alternative techniques that might overcome these limitations are then discussed. REVIEW LIMITATIONS: This review is limited in scope because it is applied to one journal, and so the findings cannot be generalized to other nursing journals or to nursing research in general. However, it is possible that other nursing journals are also publishing research articles based on the misrepresentation of random sampling. The review is also limited because in several of the articles the sampling method was not completely clearly stated, and in this circumstance a judgment has been made as to the sampling method employed, based on the indications given by author(s). CONCLUSION Quantitative researchers in nursing should be very careful that the statistical techniques they use are appropriate for the design and sampling methods of their studies. If the techniques they employ are not appropriate, they run the risk of misinterpreting findings by using inappropriate, unrepresentative and biased samples.
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Willetts L, Leff J. Improving the knowledge and skills of psychiatric nurses: efficacy of a staff training programme. J Adv Nurs 2003; 42:237-43. [PMID: 12680967 DOI: 10.1046/j.1365-2648.2003.02612.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Working with people with mental illness is very challenging and mental health workers can have a significant impact on the mental status of their patients. Few studies have been published that describe training programmes for this staff group. AIM This paper aims to describe and evaluate a training programme for generic mental health workers used in the context of a residential unit for 'difficult to place' mentally ill patients. METHOD The staff training programme was adapted from a previous programme showing good efficacy. It was conducted over 10 sessions and addressed a wide range of issues relating to the management of mentally ill patients, with the use of a variety of teaching methods. Twenty-nine generic mental health workers participated in the programme. The impact of the programme was examined using a knowledge questionnaire and a semi-structured questionnaire exploring the range and use of management strategies by staff members. RESULTS Comparison of pre- and post-training measures indicated that the training programme increased staff knowledge of schizophrenia and the use of certain management skills, in particular, systematic strategies to effect change. This included increased use of structured programmes with patients. CONCLUSION The training programme was effective in increasing knowledge and skills of staff and could be used with a variety of psychiatric staff. There are numerous limitations to this study, in particular the poor attendance rates which are likely to have decreased the impact of the programme.
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Trieman N, Leff J. Long-term outcome of long-stay psychiatric in-patients considered unsuitable to live in the community. TAPS Project 44. Br J Psychiatry 2002; 181:428-32. [PMID: 12411270 DOI: 10.1192/bjp.181.5.428] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Whereas the majority of long-stay in-patients have been successfully resettled in the community, there is a group of such patients who are too disturbed or disturbing to be managed in standard community homes. AIMS To study the long-term outcome of a group of 72 long-stay psychiatric inpatients, regarded as unsuitable for community placement. METHOD A prospective cohort study with follow-ups at 1 year and 5 years. RESULTS The patients' mental state remained unchanged after 1 year and 5 years. The level of functioning and social behaviour showed minimal change after 1 year, but then improved over the next 4 years. The profile of problematic behaviours changed significantly over 5 years, with a reduction of 50% in their frequency. Physical aggression practically disappeared. The improvements in behaviour enabled 29 patients (40% of the study group) finally to be resettled in various care homes, gaining better access to community amenities and living more independently. CONCLUSIONS A high proportion of patients with severe disabilities, designated as 'difficult to place' in the community, could benefit from slow-stream rehabilitation within specialised facilities, enabling them to move into ordinary community homes.
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Magliano L, De Rosa C, Guarneri M, Cozzolino P, Malangone C, Marasco C, Fiorillo A, Maj M. [Causes and psychosocial consequences of schizophrenia: opinions of mental health personnel]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 2002; 11:35-44. [PMID: 12043432 DOI: 10.1017/s1121189x00010137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Description of the opinions about causes and psychosocial consequences of schizophrenia in a sample of psychiatric professionals, recruited in 29 Italian Mental Health Centres (MHC). DESIGN Each professional was asked to read a case-vignette describing a patient who met the ICD-10 criteria for schizophrenia. Referring to case-vignette, he/she was asked to fill the Questionnaire on the Opinions about Mental Illness--Professionals' version (QO-P). Professionals' opinions were explored in relation to: a) their socio-demographic variables and professional background; b) geographic location of the MHC. SETTING 29 MHC stratified by geographic area (Northern, Central, Southern Italy) and population density of their catchment areas (> 100,000 inhabitants; between 100,000 and 25,000 inhabitants; < 25,000 inhabitants) and randomly selected. RESULTS Data on 465 professionals were collected. 75% of the sample identified in the vignette a case of schizophrenia, 22% of depression/anxiety disorder. Factors most frequently mentioned as causes of the detected disorder were heredity (68%), stress (61%), family difficulties (46%). More pessimistic opinions about psychosocial consequences of schizophrenia were found among nurses and among professionals of Southern Italy, among those with lower educational level, older age and among those working longer in psychiatry. No statistical difference in the opinions about psychosocial consequences of schizophrenia was found among staff who referred the case-vignette to schizophrenia and those who did not. CONCLUSIONS The results of this study outline the need to: a) include issues such as disability and psychosocial consequences of mental disorders in the basic training of professionals; b) increase the number of professionals trained in evidence-based psychosocial interventions.
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Affiliation(s)
- Lorenza Magliano
- Istituto di Psichiatria, Università di Napoli SUN, Largo Madonna delle Grazie, 80138 Napoli.
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Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev 2001:CD003267. [PMID: 11687181 DOI: 10.1002/14651858.cd003267] [Citation(s) in RCA: 231] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Communication problems in health care may arise as a result of health care providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care are increasingly advocated by consumers and clinicians and incorporated into training for health care providers. The effects of interventions that aim to promote patient-centred care need to be evaluated. OBJECTIVES To assess the effects of interventions for health care providers that aim to promote patient-centred approaches in clinical consultations. SEARCH STRATEGY We searched Medline (1966 - Dec 1999); Health Star (1975 - Dec 1999); PsycLit (1887- Dec 1999); Cinahl (1982 - Dec 1999); Embase (1985-Dec 1999) and the bibliographies of studies assessed for inclusion. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions for health care providers that promote patient-centred care in clinical consultations. Patient-centred care was defined as a philosophy of care that encourages: (a) shared control of the consultation, decisions about interventions or management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole person who has individual preferences situated within social contexts (in contrast to a focus in the consultation on a body part or disease). The participants were health care providers, including those in training. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data onto a standard form and assessed study quality for each study. We extracted all outcomes other than health care providers' knowledge, attitudes and intentions. MAIN RESULTS 17 studies met the inclusion criteria. These studies display considerable heterogeneity in terms of the interventions themselves, the health problems or health concerns on which the interventions focused, the comparisons made and the outcomes assessed. All included studies used training for health care providers as an element of the intervention. Ten studies evaluated training for providers only, while the remaining studies utilised multi-faceted interventions where training for providers was one of several components. The health care providers were mainly primary care physicians (general practitioners or family doctors) practising in community or hospital outpatient settings. In two studies, the providers also included nurses. There is fairly strong evidence to suggest that some interventions to promote patient-centred care in clinical consultations may lead to significant increases in the patient centredness of consultation processes. 12 of the 14 studies that assessed consultation processes showed improvements in some of these outcomes. There is also some evidence that training health care providers in patient-centred approaches may impact positively on patient satisfaction with care. Of the eleven studies that assessed patient satisfaction, six demonstrated significant differences in favour of the intervention group on one or more measures. Few studies examined health care behaviour or health status outcomes. REVIEWER'S CONCLUSIONS Interventions to promote patient-centred care within clinical consultations may significantly increase the patient centredness of care. However, there is limited and mixed evidence on the effects of such interventions on patient health care behaviours or health status; or on whether these interventions might be applicable to providers other than physicians. Further research is needed in these areas.
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Affiliation(s)
- S A Lewin
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, UK, WC1E 7HT.
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Kuipers E, Bebbington P, Pilling S, Orbach G. Family intervention in psychosis: who needs it? EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1999; 8:169-73. [PMID: 10638035 DOI: 10.1017/s1121189x00008034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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