The concept of spiritual care in mental health nursing

AIM

In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing.

BACKGROUND

The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care.

METHODS

A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing.

RESULTS

According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person's sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the 'mechanics of nursing'.

CONCLUSIONS

The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.

Children's Perspectives on Living With a Sibling With a Chronic Illness

CONTEXT

Clinical guidance emphasizes the importance of considering the whole family when caring for a child with a pediatric chronic illness (PCI). However, there is a lack of research specific to sibling experience. Parental accounts are used in studies to examine family experiences; consequently, the direct voices of siblings are neglected.

OBJECTIVE

The meta-synthesis was used to explore the experiences of siblings of children with PCIs to understand their perspectives; in particular, we observed what they feel had influenced their emotional well-being, to target interventions.

DATA SOURCES

We searched PsychInfo, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Academic Search Complete databases from inception to April 2016.

STUDY SELECTION

We selected qualitative articles used to examine children's perspectives of living with a sibling with a PCI. Twelve articles were reviewed.

DATA EXTRACTION

We observed participants' characteristics, qualitative methodology, analysis, and themes.

RESULTS

The thematic synthesis identified 2 overarching themes providing new insights. The first theme, "changing relationships," had 2 subthemes: "changing family relationships" and "changing relationship to self." The second theme, "managing changes," had 3 subthemes: "coping and acceptance," "support from friends, peers, and support groups," and "negative reactions from others."

LIMITATIONS

Studies were often descriptive with little explicit qualitative analysis.

CONCLUSIONS

The findings are used to outline how changes in family relationships often result in reduced communication and a suppression of healthy siblings' needs. Siblings develop strategies to help them cope with and accept their circumstances, including finding new prosocial ways of meeting their needs in the form of skills and roles they develop.

Emotion in language and speech: methodological issues in naturalistic approaches

Researchers currently seek to improve validity in speech and language studies by adopting naturalistic procedures In emotion-display research, validity is threatened by standard experimental controls which diminish the naturalism of stimuli and response ranges. We report two experiments comparing the adequacy of naturalistic with standard procedures. Experiment 1 had 158 judges code 89 samples of naturally-occurring emotional speech with free-choice emotion labels, and later with labels from a standard set. When free-choice labels were similar across judges, they were consistent with standard labels, but showed a range of intensity and contextual relevance. We recommend that future studies include wider options for judges when coding emotions. Experiment 2 compared valency ratings of words when presented in, or out of, context. Standard procedures score lexical valencies using affective dictionaries, disregarding natural contexts. Experiment 2 compared 23 judges' valency ratings of words presented individually, and later in their original context. Between 30% and 44% of words were rated differently in context (depending on the statistical significance level adopted). We concluded from Experiment 2 that, where small corpora adequately model a domain, the improved accuracy of valency rating achieved by presenting words in their natural context justifies the extra procedures required.

Mammalian inositol monophosphatase: the identification of residues important for the binding of Mg2+ and Li+ ions using fluorescence spectroscopy and site-directed mutagenesis

The fluorescence properties of residue Trp-219 in inositol monophosphatase are sensitive to the ionization of neighbouring groups. The pH-dependent changes in the fluorescence emission intensity and wavelength of maximum emission appear to arise as the result of two separate ionizations in the proximity of Trp-219, namely due to the ionization of His-217 and Cys-218. By studying the curve of fluorescence intensity against pH, given by the mutants Cys-218-->Ala or His-217-->Gln, the pK of His-217 was determined to be 7.54 and the pK of Cys-218 was estimated to be about 8.2. These mutants have altered kinetic parameters for catalytic Mg2+ ions and inhibitory Mg2+ and Li+ ions. The Cys-218-->Ala mutant enzyme is not subject to inhibition by concentrations of Mg2+ ions up to 400 mM and has a specific activity of 156% of the maximum obtainable activity of the native enzyme. The His-217-->Gln mutant enzyme shows reduced sensitivity to inhibition by Mg2+ and Li+ ions, and has a specific activity of 110% of that obtainable for the native enzyme.

Experiences of living with dystonia

PURPOSE

Dystonia is a chronic and incurable movement disorder. This qualitative study aimed to enhance understanding of the condition by exploring the experience of living with dystonia.

METHOD

Interpretative phenomenological analysis was used to analyse data gathered through semi-structured interviews. Eight participants were recruited via a UK-based dystonia charity.

RESULTS

Three superordinate themes emerged from the data: (1) dealing with ignorance and uncertainty: navigating health services with a rare, poorly understood condition; (2) the challenge of social isolation: overcoming barriers to positive social identity; and (3) fear of psychological explanations: the impact of stigmatised attitudes towards psychological explanations for dystonia symptoms.

CONCLUSION

Coping with a rare and chronic condition led to participants feeling isolated and stigmatised by health care services and their communities. Participants were able to overcome this challenge to their identities through the use of social support, particularly from other people with dystonia. Recommendations for reducing the stigmatising experiences of people with dystonia can help to ease the process of adjustment to the illness and enable people to pursue meaningful lives and positive identities. Recommendations for research are aimed at increasing knowledge about these processes.IMPLICATIONS FOR REHABILITATIONDystonia has a pervasive, negative impact on the lives of people with the condition.The struggle for diagnosis marks the beginning of a period of psychological adjustment, the difficulty of which is compounded by social isolation and stigma.Support groups and peer interaction help people to integrate dystonia into their concept of a meaningful life and identity.Health professionals should play a pivotal role in assisting patients during the process of adjustment and on-going self-management through sensitive communication and signposting to wider support services.

The development and piloting of a patient held record with adult mental health users

This article reports on the development and piloting of a patient held record for adult mental health users. Development of the format and content of the record was determined in consultation with a user group. Piloting and subsequent evaluation of the record with users revealed a number of issues which need to be addressed in the promotion of a patient held record.

Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision

In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.

Detection of metal binding to bovine inositol monophosphatase by changes in the near and far ultraviolet regions of the CD spectrum

Mg2+ ions, essential for the catalytic activity of mammalian inositol monophosphatase, increase the ellipticity in the near-ultraviolet region of the CD spectrum of the enzyme. These spectral changes are not affected by the additional presence of substrate and are reversed if EDTA is added to the solution of enzyme and metal ions. Titration of the spectral perturbation at 275 nm shows that this binding occurs with a dissociation constant (Kd) around 275 microM, 292 microM and 302 microM for the wild-type, [Gln217]inositol monophosphatase and [Phe219]inositol monophosphatase enzymes respectively. The source of the spectroscopic change at 275 nm is not Trp219. The addition of Mg2+ also causes a decrease in ellipticity over most of the far-ultraviolet region of the spectrum (between 205-240 nm). The Kd values describing the binding of Mg2+ ions are 3.9 mM, 6.8 mM and 29.1 mM for the wild-type, [Gln217]inositol monophosphatase and [Phe219]inositol monophosphatase enzymes, respectively, each showing an approximate 12% change in ellipticity. In the additional presence of 10 mM Pi, there is a fourfold increase in the affinity of wild-type enzyme for Mg2+. It is concluded that CD spectral changes at wavelengths around 275 nm are indicative of metal ions interacting with a high-affinity metal-binding site (site 1). The spectral changes around 225 nm are associated with interactions at a lower-affinity site normally occupied by the Mg2+ ion which is reflected by the Km value for this metal ion. Other metal ions such as Ca2+ and Tb3+ (but not Mn2+ or Zn2+) also perturb the CD spectrum of the enzyme in both regions of the spectrum. The amplitudes of these signal changes are greater for Mg2+ or Tb3+ (25%) ions than for Ca2+ (8.5%), although two Ca2+-binding sites with Kd values of 20 microM and 100 microM have been identified. The uncompetitive inhibitor Li+ causes little change in the near-ultraviolet spectrum in the absence or presence of either substrate or Pi. However, in contrast to other metal ions, Li+ ions elicit a 10% increase in ellipticity at 220 nm with a Kd of 0.8 mM.

Is evaluating complementary and alternative medicine equivalent to evaluating the absurd?

Complementary and alternative therapies such as reflexology and acupuncture have been the subject of numerous evaluations, clinical trials, and systematic reviews, yet the empirical evidence in support of their efficacy remains equivocal. The empirical evaluation of a therapy would normally assume a plausible rationale regarding the mechanism of action. However, examination of the historical background and underlying principles for reflexology, iridology, acupuncture, auricular acupuncture, and some herbal medicines, reveals a rationale founded on the principle of analogical correspondences, which is a common basis for magical thinking and pseudoscientific beliefs such as astrology and chiromancy. Where this is the case, it is suggested that subjecting these therapies to empirical evaluation may be tantamount to evaluating the absurd.

Understanding resilience in young people with complex mental health needs: A Delphi study

BACKGROUND

Resilience is a term used to describe an individual's adaptive coping following an adverse experience; it is important for gaining insight into the development of mental health difficulties in young people and their ability to manage adversity, informing both preventive and reactive clinical practice.

METHODS

The Delphi method was used whereby a panel of 15 clinical psychologists rated 67 statements, generated from focus groups with young people and interviews with multi-disciplinary staff, in terms of their importance relating to resilience for young people with complex mental health needs. A consensus level of 85% across the panel was set to include/exclude statements in terms of their importance for resilience.

RESULTS

Nineteen statements were included in the final list. These were grouped into the following four themes: (1) understanding the self, (2) agency in recovery, (3) interpersonal relationships and (4) therapeutic setting and relationships.

CONCLUSIONS

The results highlight specific resilience factors for young people with complex mental health needs, based upon ratings by clinical psychologists. Recommendations are made which focus upon how to promote resilience within this specific population. These include offering secure therapeutic relationships and a safe environment for young people to make decisions, develop a greater understanding of themselves, and build relationships and a sense of connection with others, both within the specialist mental health service and upon discharge.

P5713Clinical pharmacology of AZD9977, a novel, selective mineralocorticoid receptor (MR) modulator without K+-sparing properties

Background and purpose

Excessive MR activation is implicated in the pathogenesis of cardiovascular disease. MR antagonists (MRA) are effective and key guideline-directed therapy in patients with heart failure (HF) with reduced ejection fraction. However, clinical adverse events due to hyperkalaemia and a decline in renal function significantly restricts the treatment. AZD9977 is a novel, non-steroidal selective MR modulator that, compared with MRA, displays a differentiated MR-binding pattern and cofactor recruitment profile, and exerts similar organ protective effects to eplerenone with minimal effects on urinary electrolyte handling.

Methods

We performed a randomized, placebo-controlled, single-blind phase 1 study to evaluate the safety, tolerability and pharmacokinetics of oral AZD9977 in healthy men. Three sequential ascending dose cohorts were evaluated, and participants received either AZD9977 (n=6) or placebo (n=3) for 8 days. AZD9977 target doses of 50mg bid, 150mg bid and 300mg bid were explored based on a model predicted dose range comparable to and exceeding the target receptor occupancy levels achieved with approved MRA drugs. The dose of AZD9977 50mg bid is predicted to be equipotent to spironolactone 25mg daily.

Results

27 healthy male subjects aged 23–45 years completed the study. All doses of AZD9977 were well tolerated with no safety concerns identified. A total of 7 adverse events occurred in 4 participants (22.2%) receiving AZD9977 and 8 events occurred in 6 participants (66.7%) receiving placebo, none severe or resulting in withdrawal from the study. Rapid absorption of AZD9977 was observed with median Tmax values ranging from 0.5 to 0.8-hours post-dose and approximate dose proportional kinetics between 50 to 300 mg twice daily, as measured by AUCτ and Cmax. Steady-state levels in plasma were generally reached within 3–4 days. Target engagement was confirmed by a robust dose-dependent rise in mean serum aldosterone levels between Day −1 and Day 7 (Placebo = 43±172pmol/L, AZD9977 50mg bid = 132±83pmol/L, 150mg bid = 447±242pmol/L, 300mg bid = 808±330pmol/L; Figure 1). AZD9977 had no effect on blood pressure or heart rate and did not alter serum electrolyte levels, urinary Na+ excretion, log urinary Na+/K+ ratio (Figure 2), estimated GFR, or urine volumes when compared to placebo-treated subjects.

Figure 1 and Figure 2

Conclusion

These observations in humans are consistent with pre-clinical studies, demonstrating robust MR-receptor engagement without changes in serum K+ and renal electrolyte handling. These characteristics could potentially realise the therapeutic benefit of MR blockade with a low risk of hyperkalaemia. This hypothesis is currently being tested clinically in a head-to-head trial of AZD9977 versus spironolactone in patients with HF and impaired renal function (NCT03682497).

Acknowledgement/Funding

The study was Sponsored and funded by AstraZeneca