Surface electromyography (sEMG) biofeedback posture training improves the physical and mental health of early adolescents with mild scoliosis: A qualitative study

Introduction

Asymmetry in paraspinal muscle activities is observed in adolescent idiopathic scoliosis and may be of value for predicting curve progression. We have reported the effects of the surface electromyography biofeedback posture training program in improving the symmetry of paraspinal muscle activities and reducing the curve progression of early adolescents with mild scoliosis. This study further explored their subjective experience of the training program on posture correction and health-related quality of life.

Methods

Using purposive sampling, 13 early adolescents aged between 11 and 13 years with mild scoliosis participated in semi-structured in-depth interviews after completing 30 sessions of training. The data were recorded, transcribed, and coded using thematic analysis with NVivo 10. Significant statements and phrases were categorized into themes and subthemes.

Results

As assessed by X-ray, five early adolescents showed at least a 5° Cobb angle reduction in spinal curvature, while eight showed no significant curve progression (a Cobb angle change under 5°). Several subthemes related to the benefits of the training program on the health-related quality of life were generated, namely (a) posture correction, (b) improvement in body appearance, (c) restoration of muscle relaxation, (d) reduction in bodily pain and fatigue, (e) enhancement of self-confidence/self-image, and (f) improvement in social functioning.

Conclusions

Given its positive effects, the sEMG biofeedback posture training program has the potential to be an alternative early intervention for early adolescents with mild scoliosis. Further empirical studies need to be carried out to substantiate its effectiveness and evaluate the sustainability of its benefits over time.

Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study

This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.

Understanding Helpful Nursing Care From the Perspective of Mental Health Inpatients With a Dual Diagnosis: A Qualitative Descriptive Study

BACKGROUND: An estimated 30% to 50% of people with a mental illness also have a substance use problem. Referred to as having a dual diagnosis, these patients experience high levels of unmet needs, poor health outcomes, and require specialized care during psychiatric hospitalization. Research on nursing inpatients with a dual diagnosis is limited and patient perceptions of helpful care during hospitalization are unknown. AIMS: What nursing interventions, attitudes, actions, and/or behaviors are perceived as helpful by patients with a dual diagnosis during psychiatric hospitalization? METHODS: A qualitative-descriptive design was used. Twelve adult inpatients with a dual diagnosis were recruited using purposive sampling. Individual, semistructured interviews were conducted, and interview data were analyzed using content analysis. RESULTS: Helpful nursing occurred across three themes: (1) promoting health in everyday living, (2) managing substance use in tandem with mental illness, and (3) building therapeutic relationships. CONCLUSIONS: Specific examples of helpful interventions and their reported outcomes reinforce the critical role that nurses play in the health and recovery of inpatients with a dual diagnosis. The importance of collaborative, strengths-based approaches is highlighted, and expanding the nurse's role to include evidence-based responses to substance use is recommended.

Experiences of user involvement in mental health settings: User motivations and benefits

WHAT IS KNOWN ON THE SUBJECT?: User involvement, when people who have accessed services become actively involved in aspects of mental health care, can sometimes be "tokenistic" and not well thought through. Users are often involved in their own care, and asked for feedback, but are less likely to be meaningfully involved in developing services and training staff. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To implement meaningful involvement, it is important to know why some users choose to devote time to such activities. User representatives in this study, involved in a UK mental health service, wanted to help people in a similar position and give something back to those that helped them. As people started involvement activities, such as interviewing staff, they gained confidence and felt part of something that was making a difference. After being supported by staff to explore opportunities, representatives become more independent and some moved to different, sometimes salaried, roles. Some representatives did not feel valued or supported. Staff often controlled opportunities, and many users missed out on being involved. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Staff need to understand and receive training on involvement. The definition of involvement should be agreed by users and staff together, and outcomes of involvement activities must be fed-back to users on a regular basis. There should be dedicated involvement workers in services, to support individuals and integrate involvement into the system. It is important to consider how to make involvement accessible to more mental health service users. ABSTRACT: Introduction Despite guidance promoting user involvement, meaningful involvement continues to be debated within services. To effectively implement involvement, it is important to acknowledge why users devote time to such activities. Aim This study explores user representatives' experiences of involvement, including motivations and personal benefits. Method Thirteen user representatives involved in activities such as staff training and interviews were recruited from a UK National Health Service mental health Trust during 2015. Themes within semi-structured interviews were developed using constructivist grounded theory analysis. Memo-writing, process and focused coding, and core categories supported development of the conceptual framework of being a user representative. Findings Being a user representative was inextricably linked to wellness, yet staff governed opportunities. Making a difference to others and giving back were initial motivating factors. Experiences depended on feeling valued, and the theme of transition captured shifts in identity. Discussion User representatives reported increased confidence and well-being when supported by staff. However, involvement triggered mental health difficulties and identified the need for regular monitoring and reflection of involvement activities and practice. Implications for practice Services should consider coproduction, where users and staff agree together on involvement definitions. Dedicated involvement workers are crucial to supporting individual well-being and monitoring involvement.

Patients' involvement in improvement initiatives: a qualitative systematic review

BACKGROUND

Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems.

OBJECTIVES

The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care.

INCLUSION CRITERIA

This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded.

METHODOLOGICAL QUALITY

Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA EXTRACTION

Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute.

DATA SYNTHESIS

The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated.

RESULTS

Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process.

CONCLUSIONS

There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.

User participation in district psychiatry. The social construction of 'users' in handovers and meetings

An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person-centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation.

Patient perspectives of patient-centeredness in medical rehabilitation

OBJECTIVE

Achieving patient-centeredness requires a paradigm shift in the provider-patient interaction. Participation, information, communication, and interaction are essential indicators in this area. The study examined the evaluation and implementation of indicators of patient-centeredness for chronically ill patients and center-specific differences in this regard.

METHODS

This cross-sectional study with mixed-method design combined focus groups and a questionnaire survey at 5 rehabilitation centers. The analysis included a qualitative component with summarizing content analysis and a descriptive-exploratory quantitative component.

RESULTS

Patients (N=32) rated the indicators of patient-centeredness favorably to very favorably (on a scale of 1=very good to 6=unsatisfactory). The centers exhibited significant differences in "patient participation" (p<.05). Dominant topics voiced in the focus groups were the desire for more individualized treatment (n=30) and more specific and rapid feedback on treatment goals (n=13).

CONCLUSION

Considerable between-center differences exist, particularly in patients' opportunity to participate in treatment planning, which can be a starting point for improvements.

PRACTICE IMPLICATIONS

Rehabilitation centers should ask patients to evaluate indicators of patient-centeredness and develop targeted actions for improvement. The patient survey shows that patients would like improvements in patient-centeredness in the overall rehabilitation system, particularly regarding patient participation, and training in this area is recommended.

Keeping the flame alight: understanding and enhancing interest in mental health nursing as a career

Mental health nursing is not regarded favourably by most Bachelor of Nursing (BN) students as a desirable career option. However, little is known about what attracts those students who do become interested. The primary aim of the current study was to explore BN students' reasons for choosing to undertake the major in mental health nursing and the degree to which completing the subject: "Recovery for mental health nursing practice", confirmed that interest or otherwise. A secondary aim was to examine their perceptions about the attitudes of others to their expressed interest in mental health nursing. A qualitative exploratory study was undertaken with undergraduate nursing students (BN) (n = 12) enrolled in a major stream in mental health nursing. In-depth individual interviews were conducted primarily by telephone. Data were analysed using Colaizzi's steps to explicate the main themes. Two main themes emerged: Swimming against the tide - that's not real nursing, captures participants' experience of the negative attitudes of others to their interest in mental health nursing; and, creating and confirming an interest in mental health nursing, where participants discuss how their interest emerged and how it had been enhanced after completing the subject: Recovery for Mental Health Nursing Practice. Mental health nursing continues to be a stigmatised and undervalued profession both within nursing and the general public. Despite this, participants of this research were attracted to the specialty, and their interest was generally strengthened after completing the Recovery subject. Further research is required to examine the impact of being taught by an academic with lived experience on interest in mental health nursing as a career.

'Things you can't learn from books': teaching recovery from a lived experience perspective

Mental health policy in Australia is committed to the development of recovery-focused services and facilitating consumer participation in all aspects of mental health service delivery. Negative attitudes of mental health professionals have been identified as a major barrier to achieving these goals. Although the education of health professionals has been identified as a major strategy, there is limited evidence to suggest that consumers are actively involved in this education process. The aim of this qualitative study was to evaluate students' views and opinions at having been taught 'recovery in mental health nursing' by a person with a lived experience of significant mental health challenges. In-depth interviews were held with 12 students. Two main themes were identified: (i) 'looking through fresh eyes' - what it means to have a mental illness; and (ii) 'it's all about the teaching'. The experience was perceived positively; students referred to the impact made on their attitudes and self-awareness, and their ability to appreciate the impact of mental illness on the individual person. Being taught by a person with lived experience was considered integral to the process. This innovative approach could enhance consumer participation and recovery-focused care.

Continuing challenges for the mental health consumer workforce: a role for mental health nurses?

The aim of this paper is to discuss issues impacting on consumer workforce participation and challenges that continue to arise for these workers, other service providers, and the mental health system. The literature identifies the following issues as problematic: role confusion and role strain; lack of support, training, and supervision structures; job titles that do not reflect actual work; poor and inconsistent pay; overwork; limited professional development; insufficient organizational adaptation to expedite consumer participation; staff discrimination and stigma; dual relationships; and the need to further evaluate consumer workforce contributions. These factors adversely impact on the emotional well-being of the consumer workforce and might deprive them of the support required for the consumer participation roles to impact on service delivery. The attitudes of mental health professionals have been identified as a significant obstacle to the enhancement of consumer participation and consumer workforce roles, particularly in public mental health services. A more comprehensive understanding of consumer workforce roles, their benefits, and the obstacles to their success should become integral to the education and training provided to the mental health nursing workforce of the future to contribute to the development of a more supportive working environment to facilitate the development of effective consumer roles.

User involvement in mental health rehabilitation: a struggle for self-determination and recognition

AIM

The study aimed to explore service user involvement in supported housing schemes as experienced by adults with mental illness in interplay with professionals during rehabilitation.

METHOD

The study was designed as a field study in two supported housing schemes, using an ethnographic approach to data collection, including participant observation, informal conversations, and individual and group interview. Twelve participants aged 22 to 45 were included. The data analysis was informed by Ricoeur's theory of textual interpretation, and followed his three levels of interpretation: naive reading, structural analysis, and critical interpretation.

FINDINGS

The study showed that user involvement in rehabilitation was experienced by the users as a struggle for self-determination and recognition. Being able to decide and to have influence on daily activities and everyday life, together with having goals to reach during rehabilitation, were viewed as valuable. Situations without influence or involving coercion were reported especially during periods of illness or hospitalization.

CONCLUSIONS

The results of this study contribute to knowledge about user involvement from service users' perspective, and highlight the difficulties experienced in achieving self-determination and recognition during rehabilitation.

The impact of mental health nursing education on undergraduate nursing students' attitudes to consumer participation

Consumer participation in all aspects of mental health service delivery, including the education of mental health professionals, is now a policy expectation in Australia. Whether education programs introducing nurses to mental health nursing lead to more favourable attitudes towards consumer participation is yet to be examined in pre-registration nursing programs in Australia. The current evaluation examined changes in scores for the Consumer Participation Survey for undergraduate nursing students (n = 68) in an Australian University. Data were analysed, using repeated measures t-test, to compare the pre- and post-test scores. There was a significant improvement in views on consumers participating as staff members. There were no statistically significant changes in attitudes towards consumer capacity and consumer involvement in care processes. Consumer participation in mental health care is now clearly articulated in Australian Government policy. For this to be successfully implemented a more comprehensive understanding of the ability of education to influence attitudes is required.

Facilitating consumer participation: an approach to finding the 'right' consumer

Contemporary health care increasingly dictates that consumers of services should become active participants in the health care system. This has placed responsibility on administrators, managers and clinicians to include consumers in key strategic and decision making initiatives. However, this direction has not been accompanied by clear policies or guidelines. Consequently confusion about selecting consumers able to provide valuable input is identified as a barrier to active consumer involvement. The purpose of this paper is to address some concerns raised in the quest to find the "right" consumer, including: finding a consumer without an axe to grind; ensuring the consumer is representative of broader views; health professionals as consumer representatives. While these concerns are common they have not yet been extensively debated and discussed in the broader Literature. Strategies necessary to support consumers in participatory roles are also considered and the controversial subject of financial remuneration for consumers is also explored.