Healthcare professionals' views on the accessibility and acceptability of perinatal mental health services for South Asian and Black women: a qualitative study

BACKGROUND

Perinatal mental illness affects one third of new and expectant mothers. Individuals from ethnic minority groups experience higher rates of mental health problems and higher suicide rates. Despite this, women from ethnic minorities-Black and South Asian women in particular-are less likely to receive support from mental health services in the perinatal period. Healthcare professionals (HCPs) who have contact with women during this period have a unique perspective, and their views may provide insights to understand and remedy this health inequality. This study aimed to identify healthcare professionals' views on the current accessibility and acceptability of perinatal mental health services, and ways of improving services by addressing the barriers for these women.

METHODS

Semi-structured interviews were conducted with twenty-four healthcare professionals who work with patients in the perinatal period. Purposive sampling was used to select HCPs from a range of different professions (including mental health staff, midwifery, primary care, social care). The data were analysed using Framework Analysis.

RESULTS

Three main themes were identified from the data: (1) lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients; (2) patients' relationships with family, friends and healthcare professionals can both hinder and facilitate access to services; (3) healthcare professionals encourage raising awareness, flexibility, developing shared understandings and questioning assumptions to improve the accessibility and acceptability of services.

CONCLUSION

Key insights into explaining and remedying the health inequalities observed between ethnic groups were proposed by healthcare professionals. Recommendations included sharing information; taking steps to ensure each woman was considered as an individual in her relationship with her culture, ethnicity and childrearing practices; and healthcare professionals addressing their possible unconscious biases through engaging in personal reflexive practices. Reasons these are currently not being implemented deserve further research, and the potential of novel roles such as peer support workers in bridging the space between ideals and practice needs further investigation.

Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK

Background and aims

In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services?

Method

Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness.

Results

Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport.

Conclusion

Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.

Acceptability and feasibility of using avatar-based virtual world software as an adjunct to clinical interventions, training, and reflective practice in a medium secure setting: A qualitative interview study

BACKGROUND

Relationships are at the core of recovery, particularly in secure services where patients have usually had difficulties with authority figures and can have mentalisation deficits. Early indications are that avatar-based virtual world software may help facilitate communication and emotional expression.

AIMS

To establish the feasibility of using avatar-based virtual world software in a medium secure hospital, adjunctive to standard staff-patient interactions during clinical interventions and staff activities including reflective practice and training; to explore patient, staff participant and facilitator experiences using it.

METHODS

Use of the software was offered across an 89-bedded unit as an optional adjunct to clinical interventions, reflective practice and training sessions. Qualitative data were collected using semi-structured interviews and analysed using thematic analysis. Volunteer sampling was used. Five patients volunteered and were matched with an equal number of staff facilitators and participants.

RESULTS

Eighty four sessions were completed using the avatar software with between 1 and 11 participant(s) per session, totalling 347 participant sessions. No adverse events occurred relatable to the sessions. An overarching theme of 'adding value' emerged, encompassing subthemes such as 'concrete visual presence and imagery', 'mentalisation processes' and 'enhanced focus, depth and problem solving'. Experiences of added value were affected by moderators which were 'power and relationship dynamics', the 'ability to use software', 'practical processes' and 'literacy'.

CONCLUSIONS

Avatar software is feasible to implement, acceptable to patients and staff and may offer an opportunity to aid mentalisation and reflection. By definition, everyone engaging in this study was a volunteer, even an enthusiast, so it would now be useful to extend evaluation to those who need some encouragement to use avatar software. Research to quantify benefits and establish the cost impact is now indicated, as our findings show it may offer a novel way of connecting with hard-to-reach patient groups.

Exploring newly qualified nurses' experiences of support and perceptions of peer support online: A qualitative study

AIMS AND OBJECTIVES

To explore newly qualified nurses' support needs and their perceptions of online peer support.

BACKGROUND

The experience of being a newly qualified nurse is stressful and isolating. Support from colleagues and peers can enhance perceptions of competence and confidence in newly qualified nurses, improve well-being and aid retention. However, despite initiatives such as preceptorship, support needs may remain unmet in busy clinical environments. Online support has potential to offer a partial solution to professional isolation, but there is a lack of research into how technology can support nurses' emotional and social well-being.

DESIGN

A qualitative exploratory study was designed, employing semi-structured focus groups, analysed using thematic analysis. The study is reported in accordance with the COnsolidated criteria for REporting Qualitative research checklist.

METHODS

Eight focus groups, supplemented by one individual interview, were conducted with newly qualified nurses between June 2018-January 2019.

FINDINGS

Two main themes arose. The first was Drowning, a lot of the time with two sub-themes: (i) Feelings and emotions about being a Newly Qualified Nurse: 'Absolutely terrified' and (ii) Support within the role: 'Somebody you can count on'. The second was Potential advantages and disadvantages of online modality: 'Somebody is going to get in that phone!' which included three sub-themes (i) Potential advantages, (ii) Potential disadvantages and (iii) Preferences and recommendations.

CONCLUSIONS

This study demonstrates that if barriers can be overcome, then online support has potential to contribute to newly qualified nurses' well-being. Further research is needed to explore technical and ethical issues around online support and evaluate its effectiveness for newly qualified nurses.

RELEVANCE TO CLINICAL PRACTICE

Online support has the potential to add to existing strategies to support nurses during stressful times. This may be particularly relevant when many staff are working under increased pressure due to the COVID-19 pandemic.

Using technology to support the emotional and social well-being of nurses: A scoping review

AIMS

(a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research.

DESIGN

A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented.

DATA SOURCES

Between 11-12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies.

REVIEW METHODS

Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies.

RESULTS

Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community.

CONCLUSION

The review identified a dearth of research into how technology can support the well-being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed.

IMPACT

Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face-to-face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology-mediated support for the emotional and social well-being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.

Hemophilic pseudotumor of the chest

We report the progressive imaging findings of a case of hemophilic pseudotumor of the chest, not previously described. The pseudotumor, although originally extrapleural, has gradually enlarged and eroded into a bronchus, producing a bronchopleural fistula.

Polymorphonuclear leukocytes L-selectin expression decreases as they age in circulation

We recently reported that L-selectin expression increases on circulating polymorphonuclear leukocytes (PMN) during active bone marrow release, which suggests that older cells in the circulation have lower levels of L-selectin than those recently released from the bone marrow. The present study was designed to test the hypothesis that L-selectin expression reduces on PMN as they age in the circulation. In vitro studies using flow cytometry showed that PMN L-selectin decreased to 14.6 +/- 2.3% of baseline during a 24-h incubation at 37 degrees C. To test this hypothesis in vivo, rabbit PMN, labeled in vivo with 5'-bromo-2-deoxyuridine (PMN-brdU) in donor animals, were infused into recipient rabbits as whole blood (n = 5) and followed over 24 h in the circulation with a double immunolabeling technique. These results showed that the fraction of the L-selectin-negative PMN-BrdU in the circulation increased with time (P < 0.001), and nearly all of the PMNBrdU in the circulation were L-selectin negative after 24 h. Removal of L-selectin from the surface of PMN-BrdU with chymotrypsin before infusion did not change their rate of removal from the circulation (half-life or t 1/2 262 vs. 296 min, P = NS). We conclude that there is a continuous loss of L-selectin from PMN during their life span in the circulation, which supports the hypothesis that L-selectin expression decreases on PMN as they age.

A non-radioisotopic method for tracing neutrophils in vivo using 5'-bromo-2'-deoxyuridine

Polymorphonuclear leukocytes (PMN) labeled in vivo with 5'-bromo-2'-deoxyuridine (BrdU) in donor animals were transferred to recipients to determine the rate of clearance of labeled PMN from the circulation, their margination within the vascular space, and migration into Streptococcus pneumoniae-induced inflammatory sites. The donor animals received intravenous infusions at 25 mg/kg/day of BrdU for 7 days when cytospins of leukocyte-rich plasma (LRP) showed that 80 +/- 2.3% PMN were labeled. The BrdU labeled cells were then transfused to serum-compatible recipients as either whole blood, leukocyte-rich plasma, or PMN purified from an equal volume of whole blood. Twenty-four hours after transfer, the distribution of BrdU-labeled PMN in the lung, liver, spleen, bone marrow, and gut was determined morphometrically and by Southern blot analysis of DNA extracted from these organs. BrdU-labeled PMN transfused as either LRP or purified PMN provided no advantage over transfusing whole blood. The half-life of BrdU-labeled PMN in the recipient circulation after transfusing whole blood was 270.4 min (95% confidence intervals, 248.5 to 296.4 min). The majority of the BrdU-labeled DNA was found in the spleen, where DNA analysis showed that the white blood cells underwent programmed cell death by apoptosis. Four hours after infection with S. pneumoniae and 1 h after transfusion of labeled whole blood, BrdU-labeled PMN had migrated into the infected sites. We conclude that transfer of BrdU PMN in whole blood provides a simple, effective method of tracing labeled PMN in vivo.

High dose epirubicin chemotherapy in untreated poorer prognosis small cell lung cancer

A single agent chemotherapy regimen, comprising epirubicin 120 mg m-2 iv at 21-day intervals for a maximum of six cycles was administered to 26 patients with intermediate or poor prognosis small cell lung cancer. Staging consisted of both conventional disease extent and prognostic guidelines based on laboratory parameters. The overall response rate was 57% which predominantly occurred among the intermediate prognosis group (14 of 17 patients), compared with only 1 of 9 patients in the poor prognosis category. Seven patients survived for at least 12 months, including one 3-year survivor (remains disease free). Chemotherapy toxicity was easily managed and chemoresponse was generally accompanied by an improvement in perceived performance rating. The study confirms the activity of epirubicin against small cell lung cancer and emphasizes the importance of patient selection within the spectrum of small cell lung cancer.