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Biomedical subjects

J Repper

Publications and source records attributed to J Repper.

At least 19 recordsLinked to original sources
PubMed2000

Employment, social inclusion and mental health.

Whereas unemployment is clearly linked to mental health problems, employment can improve quality of life, mental health, social networks and social inclusion. Yet in the UK only 15% of people with serious mental health problems are employed--despite an overwhelming consensus from surveys, case studies and personal accounts that users want to work. This paper aims to challenge common misconceptions surrounding employment, work and mental health problems. Drawing on a range of research evidence and legislative guidance it discusses significant barriers to work and proposes feasible solutions. The need for mental health staff and services to become involved in the provision of work opportunities is considered, as is the vital role they can play in changing communities. The potency of work as a vehicle for improving the social inclusion and community tenure of people with mental health problems is highlighted.

Attitude of Health Personnel↗
PubMed1999

Evaluating clinical outcome and staff morale in a rehabilitation team for people with serious mental health problems.

Tameside and Glossop rehabilitation team (in England) have developed a progressive and targeted service for people with serious mental health problems through the systematic implementation of research-based evidence in practice and service configuration. This study was undertaken to provide a method of auditing the clinical outcome of the service and monitoring staff morale in a manner which could be integrated in the day to day delivery of services, and which could inform future service developments. Changes in the functioning of the total population of rehabilitation team clients were assessed over a 1-year period by Health of the Nation Outcome Scales (HoNOS) ratings at 6-monthly intervals. Factors causing stress and stress levels among all staff were assessed using the Mental Health Stress Questionnaire. The findings give clear indications of areas of the service which needed improving or changing, and identify ways in which the ongoing process of data collection might be refined.

Benchmarking↗
PubMed1999

A review of the literature on the prevention of suicide through interventions in accident and emergency departments.

In order to inform the development of a specialist 'suicide prevention nurse' to work in an Accident and Emergency department (A&E), a review of literature in the area was undertaken. Priority was given to papers describing well specified interventions with a carefully defined client group. Only eight such studies were identified and, although they do have clear implications for practice, they provide inadequate information regarding the targeting of all clients at risk of suicide. The review was therefore broadened to include all UK literature on suicide and parasuicide at population and individual levels. Three distinct groups of A&E attendees at particular risk of suicide were identified: patients attending A&E following deliberate self-harm; attendees with specific physical problems, and attendees with a known history of mental health problems. The needs of each of these groups are described, with their implications for the role of a 'suicide prevention nurse' in A&E. In conclusion, action to reduce suicide needs to be taken at all levels of the organization and the role of the suicide prevention nurse needs to include support, training and development as well as specific time limited therapy with a highly targeted group of patients at specific risk.

Emergency Nursing↗
PubMed1998

Difficulties in the measurement of outcome in people who have serious mental health problems.

In the present drive towards evidence-based health care it is essential for nurses to be able to define and measure their contribution in the health services and thereby ensure that resources are deployed to provide maximum improvement in the health of the population. Yet there exist few rigorous studies which examine the impact of the nursing contribution on patient health gain. One explanation for this is the sheer complexity of outcome measurement. This paper considers the multitude of factors which must be taken into account when designing studies to measure the impact of interventions for people with serious mental health problems. The heterogeneous nature of the population, the range of services these people might use, the composite of possible interventions and the paucity of adequate measurement tools are among the issues to be tackled. Although no single methodology can be prescribed, a number of principles are offered to guide study design.

Culture↗
PubMed1998

Struggling for control: the care experiences of 'difficult' patients in mental health services.

Although there is increasing recognition of the existence of 'difficult' patients who present particular challenges to mental health nurses, no research has been conducted into their perceptions of services and their experiences of care. This study identifies mental health service users who are defined by nurses as 'difficult' and explores their perceptions of their care experience. The results support earlier studies which suggested that 'difficult' patients challenge nurses' competence and control: despite their different roles both nurses and 'difficult' patients were aware of the struggle to gain or retain a notion of control. Respondents were able to identify the qualities of nurses and nursing interventions which had a positive effect on their care experience. Where nurses were perceived to demonstrate respect, time, skilled care and a willingness to give patients some control and choice in their own care, feelings of anger were reduced. These findings are discussed within the conceptual framework of 'power over' and 'power to' and implications for practice and research are considered.

Adult↗
PubMed1998

An evaluation of services for women with long-term mental health problems.

This paper presents the results of an evaluation study of services for women with long-term mental health problems. The study, which was conducted in a long-term rehabilitation and community care service, examined the adequacy, accessibility, and responsiveness of services provided for women users; explored differences between the men and women using the service and those newly admitted to it; and explored the views and experiences of service providers and the women users themselves. The results of the study confirm and extend those of previous studies and suggest a number of service recommendations. The unevenness in attention to the needs of women across services needs to be addressed. Services should be more attractive to women. Agencies and facilities for women outside mental health services should be supported to ensure that they can accommodate women with long-term mental health problems, and the women themselves need to be offered the support necessary to ensure they have access to such facilities. Finally, efforts must be made to ensure that services both recognize the losses that women with long-term mental health problems have experienced and foster their continued hopes and aspirations for the future.

Adult↗
PubMed1998

'I wanted to be a nurse ... but I didn't get that far': women with serious ongoing mental health problems speak about their lives.

Within mental health services there are fewer women than men with serious mental health problems and there is evidence that their needs are relatively neglected resulting in specific deleterious effects. In research, as in services, the abilities of women with serious mental health problems appear to be under-estimated, and there is almost a total absence of research into the views and experiences of such women. This study aimed to explore the lives of women with serious ongoing mental health problems and their experience of services, to develop understanding of the context and impact of mental distress. In a series of 5 focus group interviews, the women, who were using a range of services for people with long-term mental health problems, described lives which, even before the onset of mental health problems, were marked by material, social and personal disadvantage. Their mental health problems led to numerous losses: loss of homes, jobs, relationships, children and loss of 'normality', yet the women retained hopes and aspirations for the future. The women clearly identified aspects of the service that they valued, in particular the support and company of women workers and other women service users. The implications of these findings are discussed in relation to planning and providing mental health services for women.

Activities of Daily Living↗
PubMed1997

Mapping the difficulties experienced by clinicians and managers in health and social care who are seeking to develop research skills.

In 1994 the Department of Health commissioned project work and reviews to inform the development of a National Strategy to enhance the capacity of the NHS workforce to contribute to Research and Development. This paper reports one aspect of this review: a preliminary study mapping the difficulties experienced by clinicians and managers who sought to develop their research skills. A range of professionals were included in the sample, all of whom had applied for funding to undertake research education or training through a variety of schemes offering differing levels of support. There was a remarkable degree of consistency between the professional groups in terms of their level of training, success in achieving funding and their perception of the difficulties they faced in pursuing funding for research training--which they ranked in the same order of importance. However, two major significant differences arose: nurses and therapists rated their managers as less helpful, and they felt that completing application forms for research training was a skill that they lacked. The ranking of areas of difficulty, and the additional comments made by all respondents highlight issues that need to be addressed within a coherent strategic framework to reduce the difficulties experienced by those professionals wishing to pursue funding for research training.

Adaptation, Psychological↗
PubMed1996

Evaluating services for women with serious and ongoing mental health problems: developing an appropriate research method.

Despite an increase in the literature on women with less disabling or transitory mental health problems, there is little relating to women with serious and ongoing difficulties. In considering the means by which the needs of this population might be studied, tension arises over methodology. Research comparing the clinical, functional and service use characteristics of women and men might demonstrate their different mental health problems but would neither elucidate women's particular needs nor examine the social reasons for this difference. A feminist methodology would, however, offer a means of exploring the experiences of women, a framework for understanding sex differences, and generate findings that would be beneficial to women. The present study gives an insight into ways in which the exploration of sex differences can be combined with a study of women for women without compromising the relevance and impact of the findings.

Female↗
PubMed1995

Munchausen syndrome by proxy in health care workers.

The literature on Munchausen Syndrome by Proxy (MSP) is reviewed to assess the extent of existing knowledge and the incidence of this syndrome among health care workers. Although use of this diagnosis appears to be increasing and broadening, it was not until the Beverly Allitt case in the United Kingdom in 1993 that this syndrome was used to explain the behaviour of a health care worker who harmed people in his/her care. However, a review of available details of previous health care workers accused of murder reveals that five shared some of the distinctive features of MSP. Although care must be taken when applying diagnoses, in view of the risk of morbidity and mortality which MSP poses for the people involved, it is important that health care workers become more informed and involved in understanding and detecting MSP.

Adult↗
PubMed1994

How can nurses build trusting relationships with people who have severe and long-term mental health problems? Experiences of case managers and their clients.

Despite the shift in recent policy toward people with severe and long-term mental health problems, there is considerable evidence that mental health nurses tend to prioritize clients with acute, neurotic or short-term problems and become demoralized when working with people with persistent needs and disabilities. Mental health nurses need to find ways of developing effective relationships with these people in order to offer a service which the client is not only willing to engage in, but takes an active part in, and which allows care providers to derive satisfaction from their work. Through 46 in-depth interviews with case managers (working specifically with people with long-term mental health problems) and their clients, this qualitative study provides some guidelines for mental health nurses working in this field. Analysis of the interviews revealed that both clients and case managers focused on the problems and strategies associated with developing and maintaining relationships with one another. Furthermore, the interviews suggested that case managers adopted a philosophy for working that enabled both clients and case managers to feel positive about the work. The principles of this value base, and the way it was used in the process of case management, are explored in this account.

Adult↗
PubMedDate not supplied

Mental health: meeting the needs of neglected patients.

This article discusses part of a study of a large, well-resourced community care service. The study looked at why people with serious, ongoing mental health problems were sometimes rejected by the service or refused the care they were offered. The authors argue that these patients need the support of mental health care services although they can be difficult to care for, and suggests ways in which this can be achieved.

Community Mental Health Services↗
PubMedDate not supplied

Sound support.

Explore the source record for details and available documents.

Community Health Nursing↗
PubMedDate not supplied

Serious mental health problems: policy changes.

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.

Delivery of Health Care↗