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Curiale C, Lenzi M, Gaboardi M, Marino C, Ronconi L, Demita S, Cosentino R, Disperati F, Santinello M. Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2758-2773. [PMID: 37209420 DOI: 10.1002/jcop.23055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/25/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.
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Affiliation(s)
- Chiara Curiale
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Michela Lenzi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Marta Gaboardi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Claudia Marino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Lucia Ronconi
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Silvia Demita
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Roberta Cosentino
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Francesca Disperati
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
| | - Massimo Santinello
- Department of Developmental Psychology and Socialization, University of Padua, Padova, Italy
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Tabvuma T, Stanton R, Happell B. The physical health nurse consultant and mental health consumer: An important therapeutic partnership. Int J Ment Health Nurs 2023; 32:579-589. [PMID: 36567487 DOI: 10.1111/inm.13104] [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] [Accepted: 11/30/2022] [Indexed: 12/27/2022]
Abstract
People diagnosed with mental illness (hereon referred to as consumers) experience a disproportionately lower life expectancy of up 30 years compared to the general population. Systemic issues such as diagnostic overshadowing and stigma from healthcare professionals have inhibited the development of positive therapeutic partnerships that enable consumers to seek and engage support for their physical health concerns. Consumers have called for healthcare professionals to skillfully develop and prioritize therapeutic partnerships whilst coordinating and providing physical healthcare. The aim of this qualitative descriptive research was to explore consumer views and experiences of their interactions with a specialist mental health nursing role, the Physical Health Nurse Consultant. Semi-structured interviews were conducted with 14 consumers from a large public Community Mental Health Service in the Australian Capital Territory. Interviews were transcribed and thematically analysed. Therapeutic partnerships were an overarching theme identified from the data and included three sub-themes: personal attributes of the Physical Health Nurse Consultant; behaviour change engagement strategies; and impact of the therapeutic partnership. Consumers described the personal and professional attributes of the Physical Health Nurse Consultant that enabled the establishment and maintenance of their highly valued therapeutic partnership. This therapeutic partnership was perceived to positively impact their personal and clinical outcomes. With increasing support from consumers, clinical practice settings should move towards embedding a Physical Health Nurse Consultant role in routine practice. Further research exploring the co-development of health behaviour change goals and, barriers and facilitators experienced by the consumers regarding the Physical Health Nurse Consultant is required to further role development.
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Affiliation(s)
- Tracy Tabvuma
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Brenda Happell
- Faculty of Health, Southern Cross University, Lismore, New South Wales, Australia.,School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Reinius M, Steinsaphir Å, Malmqvist Castillo M, Stenfors T. Patients' experiences of Daily Talks: a patient-driven intervention in inpatient mental healthcare. J Ment Health 2023:1-8. [PMID: 36840358 DOI: 10.1080/09638237.2023.2182420] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Recovery is known to be enhanced by meaningful interactions between patients and mental health staff. However, nurses may become distanced from patients, and patients may spend most of their time in inpatient mental health care alone. AIMS This study aimed to explore how patients experience the intervention Daily Talks, a patient-driven innovation intended to enhance meaningful interactions between patients and staff. METHODS Fourteen in-depth interviews were performed with patients who participated in Daily Talks. The interviews were analysed using reflexive thematic analysis. RESULTS The results of the participants' experiences of Daily Talks are presented in four themes: 1.Interpersonal and active interaction where individual factors matter 2.A patient-controlled space 3.A multi-use intervention and 4.A part of the daily healthcare structure. Participants stated that Daily Talks improved the relationship between patients and their nursing staff, and they stressed the importance of patients having control over both time and content in the Daily Talks. Daily Talks was used to vent emotions and thoughts, handle situations and create strategies, and become part of a helpful structure. CONCLUSIONS The results support the value of Daily Talks, indicating that Daily Talks may facilitate helpful structures and meaningful relationships between patients and nursing staff.
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Affiliation(s)
- Maria Reinius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
| | - Åsa Steinsaphir
- User Involvement Coordinator, North Stockholm Psychiatry, Health Care Services Stockholm County, Stockholm, Sweden
| | - Moa Malmqvist Castillo
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Terese Stenfors
- Division of Learning, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Carter L, Isherwood T, Gupta A. The experience of community mental health teams by people with long-term experience of psychosis. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2022.2116474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Lucy Carter
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Isherwood
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anjula Gupta
- Assertive Outreach and R&R service, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
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Roebuck M, Latimer E, Bergeron-Leclerc C, Briand C, Durbin J, Goscha R, Krupa T, Setliff A, Vallée C, Aubry T. The Working Alliance as a Mediator Between Fidelity to Strengths Model Case Management and Client Outcomes. Psychiatr Serv 2022; 73:1248-1254. [PMID: 35502516 DOI: 10.1176/appi.ps.202100387] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to examine how the client–case manager working alliance in strengths model case management (SMCM) mediates the relationship between fidelity to the SMCM intervention and clients’ quality of life, hope, and community functioning. METHODS In total, 311 people with severe mental illness, served at seven community mental health agencies in Canada, participated in the study. They were new to SMCM and participated in five structured interviews every 4.5 months for 18 months to measure the quality of the client–case manager working alliance and clients’ quality of life, hope, and community functioning. The team-level SMCM fidelity scale was administered six times over 3 years. Ordinary least-squares path analysis was used to test simple mediation models. RESULTS Higher fidelity to SMCM was associated with better client outcomes indirectly through the working alliance. Higher SMCM fidelity predicted a stronger working alliance, which in turn predicted greater improvements in client quality of life (at 9 months and 18 months), hope (at 18 months), and community functioning (at 9 months). CONCLUSIONS The results support the view that SMCM is an effective intervention. When the intervention was implemented as planned, it fostered stronger working alliances between clients and case managers and contributed to greater improvements in the quality of life, hope, and functioning of people with severe mental illness. The findings of this study highlight the value of ongoing monitoring of implementation fidelity to achieve high-fidelity interventions that may lead to positive client outcomes.
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Affiliation(s)
- Maryann Roebuck
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Eric Latimer
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Christiane Bergeron-Leclerc
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Catherine Briand
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Janet Durbin
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Rick Goscha
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Terry Krupa
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Alissa Setliff
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Catherine Vallée
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée)
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Hammarström L, Devik SA, Hellzen O, Häggström M. "You Know Where the Boundary Is When You Cross It" - A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care. Issues Ment Health Nurs 2022; 43:712-720. [PMID: 35333659 DOI: 10.1080/01612840.2022.2053011] [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] [Indexed: 10/18/2022]
Abstract
In forensic nursing, carers must balance caring and limiting actions in encounters with patients. Interpreting suffering in others raises awareness of one's own vulnerability. Hence, the aim of this study was to describe the phenomenon of vulnerability as experienced by carers in forensic inpatient care. Nine participants were recruited at a major forensic hospital, and their narratives were analysed with a reflective lifeworld approach. The findings revealed that vulnerability was both a strength and a burden. Vulnerability comprised becoming aware of one's boundaries, being genuine and protecting oneself. Dealing with vulnerability enables carers to open up to patients.
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Affiliation(s)
| | | | - Ove Hellzen
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Marie Häggström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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A Qualitative Study of the Working Alliance in the Strengths Model of Case Management with People with Severe Mental Illness. Community Ment Health J 2022; 58:944-954. [PMID: 34669090 PMCID: PMC8527446 DOI: 10.1007/s10597-021-00903-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/02/2021] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to examine clients' perceptions of the client-case manager working alliance in the context of receiving the Strengths Model of Case Management. Twenty people with severe mental illness, with a SMCM case manager, participated in semi-structured, qualitative interviews. Using first and second cycle coding, data were analyzed thematically. People in the study attributed personal life changes to their relationship with their case manager. They valued their case managers' flexibility and highlighted their work on a wide range of goals of their choosing. Case managers approached the SMCM intervention responsive to their clients' preferences and choices. The working alliance serves as a key element of the SMCM intervention. Clients describe the working alliance as helping to improve their lives. This study supports the implementation of SMCM with people with severe mental illness due to its focus on fostering a strong working alliance.
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Torres A, Diaz P, Freund R, Baker TN, Baker AZ, Peluso P. Therapeutic alliance in vocational rehabilitation counseling: Assessing client factors and functioning. JOURNAL OF VOCATIONAL REHABILITATION 2021. [DOI: 10.3233/jvr-211165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The therapeutic relationship is often acknowledged as one of the most significant factors in clinical process that influences client outcomes. OBJECTIVE: While considerable research has been conducted on the therapeutic relationship in psychotherapy, there is a paucity of research on the impact of the therapeutic relationship in vocational rehabilitation counseling settings. METHODS: This study explored the relationship between areas of client functioning (individual, interpersonal, social, and overall) and the therapeutic alliance among clients who receive services from the State vocational rehabilitation agency. RESULTS: In this study, younger clients (ages between 16 to 29) reported stronger therapeutic alliance. CONCLUSION: The findings of this study suggested that clients’ perceived individual, interpersonal and overall functioning have a significant positive relationship with the task and bond components of therapeutic relationship.
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Affiliation(s)
- Ayse Torres
- Florida Atlantic University, Boca Raton, FL, USA
| | | | - Robert Freund
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | - Paul Peluso
- Florida Atlantic University, Boca Raton, FL, USA
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9
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Harcourt E. Epistemic injustice, children and mental illness. JOURNAL OF MEDICAL ETHICS 2021; 47:729-735. [PMID: 34172522 DOI: 10.1136/medethics-2021-107329] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
The concept of epistemic (specifically testimonial) injustice is the latest philosophical tool with which to try to theorise what goes wrong when mental health service users are not listened to by clinicians, and what goes right when they are. Is the tool adequate to the task? It is argued that, to be applicable at all, the concept needs some adjustment so that being disbelieved as a result of prejudice is one of a family of alternative necessary conditions for its application, rather than a necessary condition all on its own. It is then argued that even once adjusted in this way, the concept does not fit well in the area where the biggest efforts have been made to apply it so far, namely the highly sensitive case of adult patients suffering from delusions. Indeed it does not serve the interests of service users struggling for recognition to try to apply it in this context, because there is so much more to being listened to than simply being believed. However, the concept is found to apply smoothly in many cases where the service users are children, for example, in relation to children's testimony on the efficacy of treatment. It is suggested that further research would demonstrate the usefulness of the concept in adult cases of a similar kind.
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Affiliation(s)
- Edward Harcourt
- Faculty of Philosophy, Humanities Division, University of Oxford, Oxford, UK
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10
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Topor A, Matscheck D. Diversity, Complexity and Ordinality: Mental Health Services Outside the Institutions-Service Users' and Professionals' Experience-Based Practices and Knowledges, and New Public Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137075. [PMID: 34281012 PMCID: PMC8297002 DOI: 10.3390/ijerph18137075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022]
Abstract
In conjunction with the dismantling of psychiatric hospitals, social workers have been commissioned to help service users in their daily living in their homes and in the community. The consequences of these changes for experience-based knowledge and practices in their contexts remain relatively unknown. In this study, eighteen service users and the social workers they described as helpful for them were interviewed. The interviews were recorded, transcribed, and analyzed using Thematic Analysis. The following themes emerged: “Here, there and everywhere”, “Doing, being, becoming”, “Talking” and “Order, planning and improvisation” concerning the contradictions service users and professionals mentioned about their practices and the conditions imposed by managerial methods connected to New Public Management. Finally, “Spontaneous planned complexity” was chosen as our overarching theme to characterize the new knowledge and practices which have been developed. The displacement of the place for the encounter and the introduction of non-medicalized professions have allowed community-based practices and thus the co-creation and emergence of new knowledge about the service users as persons and the professionals as qualified professionals. The challenge remains for managers to have trust in their colleagues and not impose rigid rules, schematized methods, and repeated controls.
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Affiliation(s)
- Alain Topor
- Department of Mental Health, University of Agder, 4630 Kristiansand, Norway;
- Department of Social Work, Stockholm University, 106 91 Stockholm, Sweden
| | - David Matscheck
- Department of Social Work, Stockholm University, 106 91 Stockholm, Sweden
- Correspondence:
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11
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Sandu RD. Worthy and able: How helping relationships alter the trajectories of young people who face severe and multiple disadvantages. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:321-342. [PMID: 33053224 DOI: 10.1002/jcop.22460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Relationships with professional helpers, partly resembling family relationships, have the potential to help young people facing severe and multiple disadvantages. The aim of this study was to document how relationships alter the trajectories of young people in these circumstances. Young people (n = 30) and support workers (n = 35) were identified by the leaders of 11 UK and 5 US not-for-profit organisations providing support for this population. Thematic analysis of the semi-structured interviews revealed that relationships helped young people feel positive about themselves, disrupted their maladaptive patterns of thinking, and fostered a sense of agency in themselves. The result was a self that was worthy and able. Findings provided an in-depth exploration of the notion of support in the context of adversity.
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Affiliation(s)
- Rebeca D Sandu
- Department of Psychology, University of Cambridge, Cambridge, UK
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12
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Sandu RD, Anyan F, Stergiopoulos V. Housing first, connection second: the impact of professional helping relationships on the trajectories of housing stability for people facing severe and multiple disadvantage. BMC Public Health 2021; 21:249. [PMID: 33516187 PMCID: PMC7847021 DOI: 10.1186/s12889-021-10281-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Despite the accumulating evidence on the role of professional helping relationships for highly disadvantaged populations, methodological shortcomings have made it difficult to establish a robust relationships-outcomes link. This study sought to establish the impact of professional helping relationships on the trajectories over 24 months of housing stability for 2141 people facing severe and multiple disadvantage using data from the Housing First controlled trial in Canada. Method The study used a mixed method design. Latent growth curve and growth mixture models assessed the impact of working alliance across the sample as a whole and within subgroups with different patterns of housing stability. Thematic analysis explored the factors that may affect the quality of working alliances within different subgroups. Results Three distinct trajectories of housing stability emerged (i.e., Class 1: “sharp rise, sustained, and decline housing”; Class 2: “hardly any time housed”; Class 3: “high rise, sustained, and decline housing”) with professional helping relationships having different effects in each. The analysis revealed structural and individual circumstances that may explain differences among the classes. Conclusions The findings underscore the role of professional helping relationships, as distinct from services, in major interventions for highly disadvantaged populations, and draws new attention to the temporal patterns of responses to both the quality of relationship and targeted interventions.
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Affiliation(s)
- Rebeca D Sandu
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
| | - Frederick Anyan
- Department of Psychology, Norwegian University of Science and Technology, NO - 7491, Trondheim, Norway.
| | - Vicky Stergiopoulos
- Center for Addiction and Mental Health, University of Toronto, Bell Gateway Building, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada
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13
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Kidd S, McKenzie K, Wang W, Agrawal S, Voineskos A. Examining a Digital Health Approach for Advancing Schizophrenia Illness Self-Management and Provider Engagement: Protocol for a Feasibility Trial. JMIR Res Protoc 2021; 10:e24736. [PMID: 33492235 PMCID: PMC7870355 DOI: 10.2196/24736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background In schizophrenia spectrum populations, adherence to treatment is poor, community-based supports are limited, and efforts to foster illness self-management have had limited success. These challenges contribute to frequent, lengthy, and costly hospital readmissions and poor functional outcomes. Digital health strategies, in turn, hold considerable promise in the effort to address these problems. Objective This feasibility trial will examine a digital health platform called App4Independence (A4i), which was designed to enhance illness self-management and treatment engagement for individuals with schizophrenia. Methods Feasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period. Results This study was funded by the Canadian Institutes of Health Research in January 2020 and received Institutional Review Board approval on August 13, 2020. This study plans to begin recruiting in January 2021 and will be completed within 3 years. Data collection is projected to begin in January 2021. Conclusions This research will provide critical information for the development of this new technology in the larger effort to address a key problem in the schizophrenia field—how to leverage technology to enhance illness self-management and care engagement in resource-limited service contexts. International Registered Report Identifier (IRRID) PRR1-10.2196/24736
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Affiliation(s)
- Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sacha Agrawal
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Determinants of Therapeutic Alliance With People With Psychotic Disorders: A Systematic Literature Review. J Nerv Ment Dis 2020; 208:329-339. [PMID: 32221188 DOI: 10.1097/nmd.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis.
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Sandu RD. What is the profile of workers who build effective relationships with young people facing severe and multiple disadvantages? JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:351-368. [PMID: 31609459 DOI: 10.1002/jcop.22256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
Family-like professional helping relationships have the potential to alter the trajectories of young people facing significant disadvantage. This study seeks to identify the worker attributes that allow the formation of deep bonds with young people in these circumstances. Access to young people in difficult circumstances was secured via organisations that provided support to this population. Interviews about positive-helping relationships were conducted with young people (n = 30) and support workers (n = 35) from 11 UK and 5 US not-for-profit organisations. Thematic analysis was used to analyse the data. Three sets of worker qualities were identified and linked to how relationships change young people's trajectories in the context of adversity. This study has implications for the selection, training, and support of workers who provide support to young people facing difficult challenges underscoring the qualities needed to provide support and change young people's outcomes.
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Affiliation(s)
- Rebeca D Sandu
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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16
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Encounters with Persons Who Frequently Use Psychiatric Emergency Services: Healthcare Professionals' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031012. [PMID: 32033481 PMCID: PMC7037678 DOI: 10.3390/ijerph17031012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/25/2020] [Accepted: 02/04/2020] [Indexed: 11/16/2022]
Abstract
Encounters and interactions between healthcare professionals and patients are central in healthcare services and delivery. Encountering persons who frequently use psychiatric emergency services (PES), a complex patient group in a complex context, may be particularly challenging for healthcare professionals. The aim of the study was to explore healthcare professionals’ experiences of such encounters. Data were collected via individual interviews (N = 19) and a focus group interview with healthcare professionals consisting of psychiatric nurses, assistant nurses, and physicians. The data were analyzed with qualitative content analysis. This study focused on the latent content of the interview data to gain a rich understanding of the professionals’ experiences of the encounters. Two themes were identified: “Nurturing the encounter with oneself and colleagues for continuous, professional improvement” and “Striving for a meaningful connection with the patient”. The professionals experienced their encounters with persons who frequently use PES as caring, professional, and humane processes. Prerequisites to those encounters were knowing and understanding oneself, having self-acceptance and self-compassion, and working within person-centered cultures and care environments.
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Nielsen LD, Bech P, Hounsgaard L, Gildberg FA. Construct validity of the Mechanical Restraint - Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument. Nord J Psychiatry 2019; 73:331-339. [PMID: 31264926 DOI: 10.1080/08039488.2019.1634757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A new short-term risk assessment instrument, the Mechanical Restraint - Confounders, Risk, Alliance Score (MR - CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists' etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient's readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR - CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR - CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR - CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient's readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR - CRAS among clinicians at closed forensic mental health inpatient units. MR - CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- a Department of Psychiatry , Middelfart , Denmark.,b Nursing Education, University College South , Esbjerg , Denmark.,c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
| | - Per Bech
- e Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen , Hilleroed , Denmark
| | - Lise Hounsgaard
- c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark.,f Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland.,g University College Lillebaelt , Vejle , Denmark
| | - Frederik Alkier Gildberg
- a Department of Psychiatry , Middelfart , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
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18
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Nielsen LD, Gildberg FA, Bech P, Lange Dalgaard J, Munksgaard G, Hounsgaard L. Forensic mental health clinician's experiences with and assessment of alliance regarding the patient's readiness to be released from mechanical restraint. Int J Ment Health Nurs 2018; 27:116-125. [PMID: 27982496 DOI: 10.1111/inm.12300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
Abstract
One of the main reasons for prolonged duration of mechanical restraint is patient behaviour in relation to the clinician-patient alliance. This article reports on the forensic mental health clinicians experiences of the clinician-patient alliance during mechanical restraint, and their assessment of parameters of alliance regarding the patient's readiness to be released from restraint. We used a qualitative, descriptive approach and conducted focus group interviews with nurses, nurse assistants and social and healthcare assistants. The results show that a pre-established personal clinician-patient alliance formed the basis for entering into, and weighing the quality of, the alliance during mechanical restraint. In consideration of the patient's psychiatric condition, the clinicians observed and assessed two quality parameters for the alliance: 'the patient's insight into or understanding of present situation' (e.g. the reasons for mechanical restraint and the behaviour required of the patient to discontinue restraint) and 'the patient's ability to have good and stable contact and cooperation with and across clinicians. These assessments were included, as a total picture of the quality of the alliance with the patient', in the overall team assessment of the patient's readiness to be released from mechanical restraint. The results contribute to inform the development of a short-term risk assessment instrument, with the aim of reducing the duration of mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,University College South, Esbjerg, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Frederik Alkier Gildberg
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, København, Denmark
| | | | - Gitte Munksgaard
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.,University College of Lillebaelt, Vejle, Denmark
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Ljungberg A, Denhov A, Topor A. A Balancing Act-How Mental Health Professionals Experience Being Personal in Their Relationships with Service Users. Issues Ment Health Nurs 2017; 38:578-583. [PMID: 28388270 DOI: 10.1080/01612840.2017.1301603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although being personal in relationships with service users is commonly described as an important aspect of the way that professionals help people with severe mental problems, this has also been described to bring with it a need to keep a distance and set boundaries. AIMS This study aims to explore how professionals working in psychiatric care view being personal in their relationships with users. METHOD Qualitative interviews with 21 professionals working in three outpatient psychiatric units, analyzed through thematic analysis. RESULTS Being personal in their relationships with users was described as something that participants regarded to be helpful, but that also entails risks. Participants described how they balanced being personal by keeping a distance and maintaining boundaries in their relationships based on their "experience-based knowledge" to counter these risks. While these boundaries seemed to play an important part in the way that they act and behave, they were not seen as fixed, but rather as flexible and dynamic. Boundaries could sometimes be transgressed to the benefit of users. CONCLUSIONS Being personal was viewed as something that may be helpful to users, but that also entails risks. Although boundaries may be a useful concept for use in balancing these risks, they should be understood as something complex and flexible.
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Affiliation(s)
- Amanda Ljungberg
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden
| | - Anne Denhov
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden.,b Department of Social Work , Stockholm University , Stockholm , Sweden
| | - Alain Topor
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden.,b Department of Social Work , Stockholm University , Stockholm , Sweden.,c Faculty of Health and Sport Sciences , University of Agder , Grimstad , Norway
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20
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Virgolesi M, Pucciarelli G, Colantoni AM, D'Andrea F, Di Donato B, Giorgi F, Landi L, Salustri E, Turci C, Proietti MG. The effectiveness of a nursing discharge programme to improve medication adherence and patient satisfaction in the psychiatric intensive care unit. J Clin Nurs 2017; 26:4456-4466. [PMID: 28233457 DOI: 10.1111/jocn.13776] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To observe the extent to which a nursing discharge plan is effective in promoting therapeutic adherence and improving patient satisfaction with their treatment based on information interventions provided by nursing staff, direct hospital medication distribution and follow-up telephone calls. BACKGROUND Patient adherence is a fundamental requirement for the treatment of chronic diseases. Among psychiatric patients, adherence to the prescribed course of treatment allows patients to keep the symptoms of their disease under control, allowing for improvements in the management of their condition, minimising the risks of relapse and reducing the number of hospitalisations. DESIGN This study uses a prospective correlational design. METHODS The Morisky Medication Adherence Scale, the Satisfaction with Information about Medicine Scale and the General Satisfaction Questionnaire were used. RESULTS Of the 135 patients enrolled in the study, 57% of the sample was female, and, on average, patients were aged 33 years. About 72.9% were unmarried, and 88.1% were educated at less than high school level. This study showed that patients who received more information on their health status and on what would be done for them after their hospitalisation had a higher adherence to treatment. In addition, patients who were more satisfied with the nursing care provided had a higher rate of adherence to their treatment plan. CONCLUSIONS The interpersonal and educational nursing intervention improves adherence to a treatment plan by allowing patients to express themselves not only as individuals who rely on health care but also as protagonists able to effectively manage their disease and to empower themselves by acquiring disease management skills. RELEVANCE TO CLINICAL PRACTICE A patient-nurse communication programme could help to analyse the individual patient circumstances that might become barriers to adherence and to apply nursing interventions that promote better patient adherence.
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Affiliation(s)
- Michele Virgolesi
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | - Gianluca Pucciarelli
- University of Rome Tor Vergata, Department of Biomedicine and Prevention, Rome, Italy
| | | | | | | | - Fabio Giorgi
- Psychiatric Intensive Care Unit, Albano Laziale Hospital, Rome, Italy
| | - Lidia Landi
- San Paolo Hospital, Civitavecchia, Rome, Italy
| | - Eleonora Salustri
- Psychiatric Intensive Care Unit, Santo Spirito Hospital, Rome, Italy
| | - Carlo Turci
- Centre of Excellence for Nursing Scholarship, Rome, Italy
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Abstract
PURPOSE The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. PRIMARY PRACTICE SETTINGS One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. FINDINGS/CONCLUSIONS From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE While there are not a large number of studies available on this topic, there is sufficient evidence to warrant further examination of this research topic. The findings in this scoping study have broader implications for research, policy, and practice. The framework of this study involved an outcomes-based approach. Clinical outcomes that positively enhance patient care and save the hospital money are necessary in the current health care environment.
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22
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Topor A, Ljungberg A. “Everything is so relaxed and personal” – The construction of helpful relationships in individual placement and support. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1255276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alain Topor
- Department of Social Work, Stockholm University, Stockholm, Sweden
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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23
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Stomski NJ, Morrison P, Meehan T. Mental health nurses' views about antipsychotic medication side effects. J Psychiatr Ment Health Nurs 2016; 23:369-77. [PMID: 27353448 DOI: 10.1111/jpm.12314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: The only previous quantitative study that examined nurses' use of assessment tools to identify antipsychotic medication side effects found that about 25% of mental health nurses were using assessment tools. No previous studies have examined factors that influence the manner in which mental health nurses assess antipsychotic medication side effects. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: One-third of the respondents were not aware of any antipsychotic medication side-effect assessment tool, and only one-quarter were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools, indicating that respondents with more positive attitudes to their service were more likely to continue using antipsychotic medication assessment tools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The low level of awareness and use of antipsychotic medication side-effect assessment tools indicates that nursing educational institutions should incorporate more detail about these tools in course content, and emphasize in particular the benefits that result from the use of these tools in clinical practice. Service processes contributed significantly to the use of antipsychotic medication assessment tools, which indicates that managers need to foster workplace cultures that promote routine use of these tools. ABSTRACT Introduction Limited evidence suggests that only a minority of mental health nurses regularly use standardized assessment tools to assess antipsychotic medication side effects, but the factors that contribute to the non-routine use of these tools remain unknown. Aim To examine Australian mental health nurses' awareness of, and attitudes towards, side-effect assessment tools, and also identify factors the influence the use of these tools. Methods A cross-sectional survey was undertaken through distributing an online questionnaire via email to members of the Australian College of Mental Health Nurses. Completed questionnaires were received from 171 respondents. Linear regression was used to examine the relationship between the 'service responsibility' and 'personal confidence' scale scores, and awareness, previous use and ongoing use of antipsychotic medication assessment tools. Results Only one-quarter of the respondents (26.5%) were currently using an assessment tool. 'Service responsibility' was significantly associated with ongoing use of antipsychotic medication assessment tools (Β = 3.26; 95% CI 0.83-5.69). 'Personal confidence' did not influence the ongoing use of assessment tools (Β = -0.05; 95% CI -1.06-1.50). Implications for clinical practice Stakeholders can incorporate 'service responsibility' processes to foster increased use of assessment tools, which may enhance the identification antipsychotic medication side effects and improve the quality of care for service users.
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Affiliation(s)
- N J Stomski
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - P Morrison
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - T Meehan
- School of Medicine, University of Queensland, Richlands, QLD, Australia
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Simpson A, Hannigan B, Coffey M, Barlow S, Cohen R, Jones A, Všetečková J, Faulkner A, Thornton A, Cartwright M. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study. BMC Psychiatry 2016; 16:147. [PMID: 27184888 PMCID: PMC4868048 DOI: 10.1186/s12888-016-0858-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care. METHODS We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method. RESULTS Significant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery. CONCLUSIONS Administrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common understandings of recovery which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated.
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Affiliation(s)
- Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK.
- East London NHS Foundation Trust, 9 Alie St, London, E1 8DE, UK.
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, CF10 3XQ, UK
| | - Michael Coffey
- Department of Public Health Policy and Social Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK
| | - Rachel Cohen
- Department of Public Health Policy and Social Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, CF10 3XQ, UK
| | - Jitka Všetečková
- Faculty of Health and Social Care, The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, UK
| | | | - Alexandra Thornton
- Centre for Mental Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK
| | - Martin Cartwright
- Centre for Health Services Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK
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Stomski NJ, Morrison P, Meyer A. Antipsychotic medication side effect assessment tools: A systematic review. Aust N Z J Psychiatry 2016; 50:399-409. [PMID: 26480934 DOI: 10.1177/0004867415608244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to critically appraise the psychometric properties of antipsychotic medication side effect assessment tools. METHODS Systematic searches were undertaken in PubMed, CINAHL and CENTRAL from inception to October 2014. Studies were included if they detailed the evaluation of psychometric properties of antipsychotic medication side effect assessment tools in mental health populations. Studies were excluded if they examined the use of antipsychotic medication side effect assessment tools in non-mental health populations, including people suffering from dementia, Parkinsonism and Alzheimer's. Narrative reviews and studies published in any language other than English were also excluded. RESULTS Content validity was appropriately established for only one of the tools, reliability was inappropriately evaluated for all but one tool, and the assessment of responsiveness was not acceptable for any tool. CONCLUSION Further psychometric studies are warranted to consolidate the psychometric properties of the included antipsychotic medication side effect assessment tools before any of these tools can be confidently recommended for either research or clinical purposes.
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Affiliation(s)
- Norman Jay Stomski
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Paul Morrison
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Amanda Meyer
- School of Health Professions, Murdoch University, Murdoch, WA, Australia
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26
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Simpson A, Hannigan B, Coffey M, Jones A, Barlow S, Cohen R, Všetečková J, Faulkner A. Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP). HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alan Simpson
- School of Health Sciences, City University London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Michael Coffey
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sally Barlow
- School of Health Sciences, City University London, London, UK
| | - Rachel Cohen
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - Jitka Všetečková
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
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Verhaeghe S, Duprez V, Beeckman D, Leys J, Van Meijel B, Van Hecke A. Mental Health Nurses' Attitudes and Perceived Self-Efficacy Toward Inpatient Aggression: A Cross-Sectional Study of Associations With Nurse-Related Characteristics. Perspect Psychiatr Care 2016; 52:12-24. [PMID: 25495430 DOI: 10.1111/ppc.12097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/25/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To explore mental health nurses' attitude and self-efficacy to adult inpatient aggression, and to explore the association with nurse-related characteristics. DESIGN AND METHOD Cross-sectional study in a sample of 219 mental health nurses in nine psychiatric hospitals, with stepwise linear regression analysis to detect predictive models. FINDINGS Female and less experienced nurses were less likely to blame patients for their behavior. Gender, burnout, secondary traumatic stress, and compassion satisfaction accounted for 26.2% of the variability in mental health nurses' self-efficacy toward aggression. PRACTICE IMPLICATIONS There needs to be attention to professional quality of life for mental health nurses, to provide them with of self-efficacy and a positive attitude toward coping with aggression.
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Affiliation(s)
- Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nursing, Vives University College Leuven, Roeselare, Belgium
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Joris Leys
- Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Berno Van Meijel
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Nursing Science, University Hospital Ghent, Ghent, Belgium
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Ljungberg A, Denhov A, Topor A. Non-helpful relationships with professionals - a literature review of the perspective of persons with severe mental illness. J Ment Health 2015; 25:267-77. [PMID: 27150468 DOI: 10.3109/09638237.2015.1101427] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship with professionals has proved to be important with regard to outcome for persons with severe mental illness (SMI). The understanding of non-helpful relationships is important complementary knowledge to that regarding helpful relationships. AIM To review the available qualitative research providing knowledge of non-helpful relationships from the perspective of persons with SMI. METHOD A review of qualitative studies, based on an earlier systematic search, analyzed through thematic analysis. RESULTS The main themes were "non-helpful professionals", "organization versus relation" and "the consequences of non-helpful relationships with professionals". Examples of professionals described as non-helpful were pessimistic and uncaring professionals who were paternalistic and disrespectful. Discontinuity, insufficient time and coercion were some of the contextual factors described as non-helpful. These sorts of relationships were non-helpful because they hindered helpful relationships from developing and contributed to further suffering, instilling hopelessness and hindering personal growth. CONCLUSIONS Non-helpful relationships with professionals can be understood as impersonal relationships that contain no space for negotiation of the relationship nor of the support and treatment provided through it. It is important that organizations provide professionals with favorable conditions to negotiate the organizational framework and to treat persons with SMI as whole human beings.
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Affiliation(s)
- Amanda Ljungberg
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden
| | - Anne Denhov
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden .,b Department of Social Work , Stockholm University , Stockholm , Sweden , and
| | - Alain Topor
- a Research and Development Unit , Psychiatry South Stockholm , Stockholm , Sweden .,b Department of Social Work , Stockholm University , Stockholm , Sweden , and.,c Faculty of Health and Sport Sciences , University of Agder , Grimstad , Norway
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Morrison P, Meehan T, Stomski NJ. Australian case managers' views about the impact of antipsychotic medication on mental health consumers. Int J Ment Health Nurs 2015; 24:547-53. [PMID: 26257312 DOI: 10.1111/inm.12154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study examined case managers' views about antipsychotic medications and the impact of side-effects on mental health consumers in a community setting. Nine case managers were purposively sampled and interviewed. Content analysis was used to generate a series of themes. The findings indicated that case managers perceived that a lack of consumer insight was one of the main reasons for wanting to reduce, or altogether cease, antipsychotic medication. However, case managers lacked an adequate level of knowledge about antipsychotic medication side-effects. Without a sufficient level of knowledge, case managers may be unable to fully address consumers' concerns.
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Affiliation(s)
- Paul Morrison
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
| | - Tom Meehan
- The Park Centre for Mental Health, University of Queensland, Richlands, Queensland, Australia
| | - Norman J Stomski
- School of Health Professions, Murdoch University, Murdoch, Western Australia, Australia
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Ljungberg A, Denhov A, Topor A. The Art of Helpful Relationships with Professionals: A Meta-ethnography of the Perspective of Persons with Severe Mental Illness. Psychiatr Q 2015; 86:471-95. [PMID: 25631156 DOI: 10.1007/s11126-015-9347-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Relationships with professionals have been shown to be helpful to persons with severe mental illness (SMI) in relation to a variety of services. In this article, we aimed to synthesize the available qualitative research to acquire a deepened understanding of what helpful relationships with professionals consists of, from the perspective of persons with SMI. To do this, we created a meta-ethnography of 21 studies, through which ten themes and an overarching interpretation were created. The findings show that helpful relationships with professionals are relationships where the persons with SMI get to spend time with professionals that they know and trust, who gives them access to resources, support, collaboration and valued interpersonal processes, which are allowed to transgress the boundaries of the professional relationship. The overarching interpretation shows that the relationship that persons with SMI form with professionals is a professional relationship as well as an interpersonal relationship. Both these dimensions entail actions and processes that can be helpful to persons with SMI. Therefore, it is important to recognize and acknowledge both the functional roles of service user and service provider, as well as the roles of two persons interacting with each other, in a manner that may go beyond the purview of the traditional professionalism. Furthermore, the helpful components of this relationship are determined by the individual preferences, needs and wishes of persons with SMI.
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Affiliation(s)
- Amanda Ljungberg
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
| | - Anne Denhov
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
- Department of Social Work, Stockholm University, Stockholm, Sweden.
| | - Alain Topor
- Research and Development Unit, Psychiatry South Stockholm, Box 5040, 121 05, Johanneshov, Stockholm, Sweden.
- Department of Social Work, Stockholm University, Stockholm, Sweden.
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
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31
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Stegink EE, van der Voort TYGN, van der Hooft T, Kupka RW, Goossens PJJ, Beekman ATF, van Meijel B. The Working Alliance Between Patients With Bipolar Disorder and the Nurse: Helpful and Obstructive Elements During a Depressive Episode From the Patients' Perspective. Arch Psychiatr Nurs 2015; 29:290-6. [PMID: 26397431 DOI: 10.1016/j.apnu.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 01/03/2023]
Abstract
Despite treatment, many patients with bipolar disorder experience impaired functioning and a decreased quality of life. Optimal collaboration between patient and mental health care providers could enhance treatment outcomes. The goal of this qualitative study, performed in a trial investigating the effect of collaborative care, was to gain more insight in patients' experiences regarding the helpful and obstructive elements of the working alliance between the patient recovering from a depressive episode and their nurse. Three core themes underpinned the nurses' support during recovery: a safe and supportive environment, assistance in clarifying thoughts and feelings, and support in undertaking physical activities.
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Affiliation(s)
- Eva E Stegink
- Center for mental healthcare GGz Centraal, Lelystad, The Netherlands.
| | | | - Truus van der Hooft
- Faculty, Clinical Health Sciences, Faculty of Medicine, Utrecht University, The Netherlands
| | - Ralph W Kupka
- VU University Medical Center, Dept. of Psychiatry, Amsterdam, The Netherlands; Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
| | - Peter J J Goossens
- Dimence Mental Health, Deventer, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; GGZVS Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands.
| | - Aartjan T F Beekman
- VU University Medical Center, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Berno van Meijel
- VU University Medical Center, Dept. of Psychiatry, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Research Group Mental Health Nursing, Department of Health, Sports & Welfare/Cluster Nursing, Amsterdam, The Netherlands; Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands.
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Simpson A, Hannigan B, Coffey M, Jones A, Barlow S, Cohen R, Všetečková J, Faulkner A, Haddad M. Study protocol: cross-national comparative case study of recovery-focused mental health care planning and coordination (COCAPP). BMC Psychiatry 2015; 15:145. [PMID: 26138855 PMCID: PMC4490676 DOI: 10.1186/s12888-015-0538-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively. METHODS/DESIGN COCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday 'frontline' practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding. DISCUSSION COCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.
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Affiliation(s)
- Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University London, London, UK.
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Michael Coffey
- Department of Public Health and Policy Studies, Swansea, UK.
| | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City University London, London, UK.
| | - Rachel Cohen
- Department of Public Health and Policy Studies, Swansea, UK.
| | - Jitka Všetečková
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
| | | | - Mark Haddad
- Centre for Mental Health Research, School of Health Sciences, City University London, London, UK.
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Zugai JS, Stein-Parbury J, Roche M. Therapeutic alliance in mental health nursing: an evolutionary concept analysis. Issues Ment Health Nurs 2015; 36:249-57. [PMID: 25988275 DOI: 10.3109/01612840.2014.969795] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.
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Affiliation(s)
- Joel Sebastian Zugai
- University of Technology Sydney, Faculty of Health, Sydney, New South Wales, Australia
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Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach. Soc Psychiatry Psychiatr Epidemiol 2015; 50:363-70. [PMID: 25242154 DOI: 10.1007/s00127-014-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/08/2014] [Indexed: 01/24/2023]
Abstract
PURPOSE The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year. METHODS Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis. RESULTS Four main patterns of alliance were identified: (1) high and stable (HS, 45.6 %), (2) high and increasing (HI, 36.9 %), (3) high and decreasing (HD, 11.3 %) and (4) low and increasing (LI, 6.1 %). Predictors of class membership were duration of illness, ethnicity, and education, receipt of state benefits, recovery, and quality of life. CONCLUSIONS Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.
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Rosti-Otajärvi E, Mäntynen A, Koivisto K, Huhtala H, Hämäläinen P. Predictors and impact of the working alliance in the neuropsychological rehabilitation of patients with multiple sclerosis. J Neurol Sci 2014; 338:156-61. [DOI: 10.1016/j.jns.2013.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/22/2013] [Accepted: 12/24/2013] [Indexed: 01/28/2023]
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