Parents' Experiences and Nurses' Perceptions of Decision-Making About Childhood Immunization

BACKGROUND

Immunization in Canada is recommended not mandated, granting parents discretionary decision-making power regarding their child's immunization status. Uptake of childhood immunization at present falls below national targets. Nurses who interact with parents in the clinical setting may witness parents' decision-making experiences, attitudes, and opinions inclusive of vaccine hesitancy.

PURPOSE

The aim of this study is to understand parents' and nurses' experiences of decision-making about childhood immunization, specifically measles-mumps-rubella and/or diphtheria-tetanus-acellular pertussis.

METHODS

Thorne's interpretative description approach was used to understand parents' and nurses' experiences and perspectives about immunization. The sample was 6 nurses and 16 parents residing in northeastern Ontario.

RESULTS

Common to all participants was the goal of protection. Motivated by child protection, parents carried out three broad actions, searching for information, deliberating the information and sources to determine the relative benefits and risks of immunization, and bearing responsibility for their decision to accept, delay, or decline immunization. Nurses were motivated by child protection and population health.

CONCLUSION

Implications for nursing included integration of immunization competencies in nursing curricula, ongoing professional development, validation of parental actions for child protection, nurse-led education sessions, and engaging parents through social media to support access to reputable information.

Priorities for Supportive Housing Services: Perspectives of People With Mental Illness in Northeastern Ontario

Background

Accessible, appropriate, and affordable housing is recognized as essential for the well-being of all Canadians. Securing and maintaining housing tenure for individuals living with chronic health and social challenges can be compromised without appropriate services. There has been limited research into the priorities to enhance supportive housing services from the perspective of individuals living with mental illness in smaller urban and rural communities.

Purpose

The purpose was to describe the priorities for supportive housing from the viewpoints of tenants recovering from mental illness in northeastern Ontario.

Methods

This descriptive study used Q methodology to engage 52 adults regarding their impressions about enhancing supportive housing services. Participants ranked 39 housing and support priority statements on a nine-point Likert-type scale.

Results

Four discrete viewpoints about priorities for supportive housing were building a home, letting others in, moving outside the walls, and accessing personalized services. Common across these viewpoints was the need to increase financial assistance offered through existing programs.

Conclusions

Fostering individual pathways to recovery involves mitigating health and social disparities, relative to supportive housing, one size does not fit all. Service providers and decision makers are compelled to situate each individual within an evidence-informed supportive housing system for citizenship.

Healthcare Providers' Experiences as Arts-Based Research Participants: "I Created My Story About Disability and Difference, Now What?"

Little is known about the experiences of healthcare providers as research participants in qualitative studies employing methods that encourage disclosure of their own disabilities. In this paper, we describe the experiences and implications of creating personal stories of disability and difference for healthcare provider participants in an arts-based study. The study design is a supplementary secondary analysis of a subset of data from a larger study focused on transforming negative concepts of disability and difference entitled, Mobilizing New Meanings of Disability and Difference: Using Arts-Based Approaches to Advance Healthcare Inclusion for Women with Disabilities. This supplementary study explores the experiences and perspectives of 17 healthcare provider participants who completed semi-structured interviews following creation of a multi-media story about their experience of disability or difference. Using creative non-fiction methods, two narrative streams are identified about healthcare provider experiences and the impacts of participating. The first addresses shared positive experiences about the research. The second entails more ambivalent reflections on their involvement as participants. The tension between the two experiences generates considerations to forward a mutually beneficial alliance to disrupt ableist understandings in healthcare and reveals new meanings of disability that are agential and integral to the stories and storytellers themselves.

Not sick enough: Experiences of carers of people with mental illness negotiating care for their relatives with mental health services

WHAT IS KNOWN ON THE SUBJECT?: Existing literature provides insight into the general experience of carers of people with a mental illness. Previous studies have found that carers experience a range of emotions when looking after their relatives with a mental illness. However, experiences of carers as they engage with the healthcare system is largely absent from the literature. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper identified the experiences of carers when their relatives are experiencing a crisis or acutely unwell. Carers found themselves in the middle between mental health services and their relatives. Strategies employed by carers to ensure their relatives receive adequate care were identified from this study. This paper identified how carers needed to become more assertive in order to receive adequate care for their relatives, and this finding has implications for any future carer education. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The participants identified the need to work more collaboratively with carers of people with a mental illness as they seek treatment for their relatives in order to achieve better health outcomes for the patients. Improved health service engagement of carers was seen by participants to assist them to better care for their relative. The study also found that there needs to be a clearer definition as to what constitutes mental health crisis and how carers are able to intervene during this period. Services could provide clear information concerning crisis services and in particular triage.

ABSTRACT

Aim The literature reporting experiences of relatives of people with mental illness regarding their interactions with mental health services identifies many commonalities. However, the actual experience of carers engaging the services and understanding healthcare systems remains a gap in the literature. The aim of this study was to explore the experiences of carers (of people with a severe mental illness) in a major area mental health service in Victoria Australia as they fulfil their caring role while negotiating support for their relative. A carer is defined as a family member or significant other who is the primary individual who provides informal care for a person with severe mental illness and may or may not be in receipt of income supplement for such a role. Specifically this study has a focus on the experience of the carer when negotiating care needs or admission with a mental health service. Method A qualitative descriptive approach was used with five focus groups as a means of data collection. Ethical approval for the study was obtained from both the hospital and universities ethics committees. Results Key themes identified using thematic analysis are presented in the words of the carers and include: "Juggling" between services; We became assertive and If only they would listen. Often carers were advocating for their relative and needing to negotiate between services (police and crisis assessment teams) to gain any form of assessment or intervention. Carers often spent a great deal of time on the phone to services only to be told that their relative was "not sick enough" to access care or that no response would occur without another service also being involved. Discussion Our research highlights the importance of working collaboratively with informal carers and acknowledging their valuable contribution to the care of their relatives with a severe mental illness. It is very important that adequate support is given to carers especially during the period when their relatives are experiencing a crisis. An understanding of their experiences ensures a more family focused approach towards care. The study findings should enable the healthcare team to focus attention on the issues which are most pertinent to carers. Nurses are advocates not only for the patient but also for their families. Relevance statement Carers supporting a person who experiences mental illness can often find themselves in difficult and emotionally challenging situations such as at times of crisis and admission to mental health services. The fourth and latest Australian National Mental Health Plan (2009-2014) acknowledged these concerns and highlighted the need to recognize the role of carers in promoting well-being and recovery of the relative with a mental illness. The plan acknowledges that families are often best placed to recognize signs of relapse in their family members with a mental illness and discharge planning should include the involvement of family members (Commonwealth of Australia, ). To achieve best care outcomes for consumers, mental health nurses need to recognize the role of the carer and collaborate in care planning.

Canadian community mental health workers' perceived priorities for supportive housing services in northern and rural contexts

A relationship between mental health and supportive housing has been established, yet there exist enduring challenges in meeting the supportive housing needs of people with severe mental health problems. Furthermore, not all stakeholder viewpoints of supportive housing services are well documented in the research literature, and research has tended to focus on supportive housing provision in large, urban centres. Potentially, distinct challenges and opportunities associated with the provision of supportive housing services in smaller urban and rural communities that define the greater geographical terrain of Canada and other jurisdictions are less developed. This study describes community mental health service workers' priorities for supportive housing services. Using Q methodology, 39 statements about supportive housing services, developed from a mixed-methods parent study, were sorted by 58 service providers working in four communities in northern Ontario, Canada. Data used in this study were collected in 2010. Q analysis was used to identify correlations between service workers who held similar and different viewpoints concerning service priorities. The results yielded four discrete viewpoints about priorities for delivery of supportive housing services including: a functional system, service efficiency, individualised services and promotion of social inclusion. Common across these viewpoints was the need for concrete deliverables inclusive of financial supports and timely access to adequate housing. These findings have the potential to inform the development of housing policy in regions of low population density which address both system and individual variables.

What does practice development (PD) offer mental health-care contexts? A comparative case study of PD methods and outcomes

Practice development (PD) in mental health nursing has been progressing over the last decade; however, the level and impact of PD activity in the field of mental health remains poorly understood outside localized project impact. More specific reporting and comparative analysis of PD outcomes will improve this situation. In response, this paper presents three case scenarios from work taking place in Australia and New Zealand, as working examples of how PD methodologies have been applied within mental health practice settings. Using a comparative framework that captures the contributing assumptions, practices, processes and conditions imperative to effective PD work within a mental health-care context, three case vignettes are reviewed. The critical question driving this paper is 'what mental health-care services does PD offer in terms of transformational change approaches and the promotion of effective workplace cultures?' Conditions considered necessary for successful PD initiatives within mental health contexts are explored such as how PD converges and diverges with mental health-related theories, plus where and how PD activity best integrates with the specific elements associated with mental health-care provision. The findings are further reviewed in line with reports of PD outcomes from other fields of health care.

Midwives and assessment of perinatal mental health

Childbirth involves many psychological and emotional changes for women. The recent Commonwealth Government of Australia, National Perinatal Mental Health Action Plan (in 2008) recommends all pregnant and postnatal women have a psychosocial assessment including completion of the Edinburgh Postnatal Depression Scale. Midwives will assess all women at antenatal 'booking in' to maternity services. Currently, midwives receive little education regarding mental health assessment of women. This study explored the perceptions of midwives of their own mental health skills, knowledge and experiences, when working with women with mental illness in the perinatal period. An exploratory descriptive design was utilized to survey midwives across 19 maternity sites in Victoria, Australia. Clearly, midwives lack mental health skills and knowledge, describing their lack of confidence and feeling uncomfortable and unsafe when providing care for women with mental illness. They also report little knowledge of resources available to provide appropriate services for these women. The future direction for improving maternity care will require midwives to assess mental health needs of women, and refer them on, for timely intervention. It is critical midwives are prepared and able to make this kind of assessment.

Homelessness, a state of mind?: a discourse analysis

This article presents a discourse analysis of a woman's written account of mental illness and homelessness. In her preparation as a co-presenter at a conference for decision- and policy-makers, Anna wrote eight distinct drafts of her speaking notes; each time emphasizing different aspects of her experiences with mental illness and homelessness. By sharing her preparatory writings, Anna offers a rare insight into the 'evolution' of the thinking that went into representing her story to an audience of professionals. In addition, this analysis represents an interpretation and alternative forum to learn from Anna's story.

Vasospasm-induced heart block

A syncopal episode in an elderly patient with a history of carotid disease, multiple cardiac risk factors, and new onset chest pain presents diagnostic challenges. This case study describes the experience of a woman with coronary vasospasm accompanied by conduction deficits. The patient's history, diagnostic work-up, and treatment program are presented. The relationship between the coronary artery anatomic defects and the conduction abnormalities are discussed.

Learning retention in patients receiving midazolam during permanent pacemaker implantation

This pilot study (N = 20) tested the effects of intravenous midazolam administration on learning retention after pacemaker implantation. Patients were randomized to receive teaching at 1 or 3 hours after the last dose of midazolam. Using a standardized teaching format, one of two study nurses performed the teaching that included incision care, activity restrictions, environmental factors potentially affecting pacemaker function, and follow-up requirements. Learning was evaluated by one of the investigators blinded to teaching time. Subjects in the 1-hour group retained significantly less information than those taught at 3 hours after drug administration. Patients taught later answered similar numbers of questions correctly, whereas there was much more variability in correct responses for the group taught earlier. This article reviews the effects of midazolam on memory and learning as well as provides suggestions for alterations in patient education protocols for patients receiving midazolam for pacemaker implantation. The effect of shortened length of stay on care practices is also discussed.

Thyrotoxic atrial fibrillation: pathophysiology, detection, and management

Hyperthyroidism is a frequently misdiagnosed cause of atrial fibrillation. Difficulties associated with diagnosis are related to physiologic idiosyncrasies, concomitant illnesses, and medication regimens that may alter thyroid function and thyroid function tests. These factors are described. Nurses have a key role in assisting patients to manage hyperthyroidism and atrial fibrillation through case finding, assessment, education, and psychological support.

Why me? Causal thinking, affect, and expectations in myocardial infarction patients

This study investigated whether patients who seek an explanation for their heart attack, as compared to those who do not, differ in their affect, in expectations about their future recovery, and in expectations about coping with their future. Forty-two myocardial infarction patients were interviewed, in both the acute and convalescent stages, as to whether they had thought about "Why me?" Approximately half of the patients at each stage reported searching for an answer to that question. The patients remained generally consistent in their self-reported anxiety, depression, and hostility over time; however, patients who had not thought about "Why me?" reported less anxiety than those who had. No significant differences were found in affect in patients who gave a specific cause for their heart attack and in those who could not. Patients were significantly less optimistic about their future recovery at follow-up than when they were in the hospital, but there were no differences in expectations for future recovery or for future coping of those who had and those who had not thought about "Why me?"

On the prevalence of causal search in illness situations

The prevalence of causal search was examined in two samples, one of chronically ill patients, the other of acutely ill patients. In contrast to the assumption that causal search occurs in important or unexpected life events, the results indicated that such a search was reported by only about half of 296 long-term diabetic, hypertensive, and arthritic patients and 83 newly diagnosed myocardial infarction patients. Moreover, in both samples, affect and expectancies for the future were better for those who had not engaged in causal search. Further research to examine the questions used to elicit causal responses and to test the assumption that causal thinking takes place is suggested.

Learning to live with controlled ventricular tachycardia: utilizing the Johnson model

In view of the multifaceted needs of both patients and families, the role of the nurse lies in assessing system instability and in prioritizing efforts for stabilization within the hospital. Since the problems are so complex, it may be impossible to resolve all of them before discharge. Therefore, follow-up referrals to counseling services and visiting nurse associations are helpful. Of added benefit is an ongoing, supportive relationship with a physician and/or a nurse specialist who is familiar with the needs of these special patients and their families. The use of a behavioral systems model such as Johnson's assists the nurse in organizing assessments of patient and family needs and in planning nursing strategies to meet those needs. The patient's very realistic fears of dying coupled with the frequently occurring loss of cardiac function present an enormous challenge to the nurses who work with them. The close professional relationships that result from this process are extremely rewarding.