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PubMedDate not supplied

Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics.

Although posttraumatic stress disorder (PTSD) is relatively common in community epidemiologic surveys (5-6% for men, 10-12% for women), and psychiatric patients with PTSD are known to have poor functioning and high levels of psychiatric comorbidity, there are no studies that address PTSD prevalence, functioning, and burden in primary care settings. This article reports on (1) the prevalence of PTSD using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnostic criteria in Veterans Affairs (VA) primary care settings, (2) associated sociodemographic characteristics and comorbidities, (3) functional status related to PTSD, (4) the extent to which PTSD was recognized by providers and (5) health services use patterns (including specialty mental health) of PTSD patients. Patients were randomly selected from those who had an outpatient visit in FY 1999 at one of four VA hospitals; 888 patients consented (74.1% of 1198 contacted); 746 patients (84.0% of consenting patients; 62.3% of contacted patients) were reached for telephone diagnostic interviews. Diagnostic interviews with the Clinician Administered PTSD Scale yielded estimates of current PTSD prevalence of 11.5%. At statistically significant levels, PTSD was positively associated with a variety of comorbid psychiatric disorders, war zone service, age <65 years, not working, less formal education and decreased functioning. Of patients diagnosed with PTSD by study procedures, 12-month medical record review indicated that providers identified only 46.5% and only 47.7% had used mental health specialty services. PTSD-positive [PTSD(+)] patients who used mental health care in the past 12 months were more apt to be identified as having PTSD than nonmental health service users (78.0% vs. 17.8%). Although PTSD(+) patients had more medical record diagnoses than PTSD-negative [PTSD(-)] patients (6.28 vs. 4.95), their use of primary care, urgent care and inpatient care was not different from PTSD(-) patients.

Adolescent↗

PubMed2007

A survey of the education of nurses working in mental health settings in 12 European countries.

BACKGROUND: Recent European policies emphasise that the training and education of health professionals are a major means of improving mental health services. Little comparative research has been undertaken to ascertain the degree of homogeneity in the training of nurses working in mental health settings across Europe. OBJECTIVE: The aim of this study was to investigate the training of nurses working in mental health settings in a range of European countries. Specifically, information regarding criteria for entry into training, type of qualification awarded and further training opportunities was to be explored. METHODS AND PARTICIPANTS: A specially designed questionnaire was designed to gather data from senior mental health nurses working in the mental health field in a sample of 12 countries from across Europe. RESULTS: Findings disclosed considerable disparity between countries in respect to nurse training, with few countries requiring a specialist nursing qualification to practice in the mental health field. There appears to be little homogeneity in terms of educational provision pre and post-qualification. CONCLUSIONS: More research is needed into how European states deliver nurse training and education, how students are prepared for various practice settings and the effect on outcomes for service users of different models of training.

Clinical Competence↗

PubMed2006

Implementing holistic practices in mental health nursing: a national consultation.

BACKGROUND: A national consultation exercise was held as part of a review of mental health nursing in England. OBJECTIVES: To gather views as to how best to develop mental health nursing to support a holistic approach to care, taking into account psychological, physical social and spiritual needs. DESIGN: National open consultation by email over a 3-month period. PARTICIPANTS: 326 written replies were received. The largest group of responses was from National Health Service (NHS) organisations (n=92, 28.2%); 69.9% of responses were from groups or organisations (n=225). METHODS: A consultation document was devised by a national reference group, including four questions relating to the development of practice in the four domains of: psychological, physical, social and spiritual care. RESULTS: The majority of responses supported mental health nurses (MHNs) providing psychological therapies (n=271, 95.1%). To support this happening, responders most frequently described a need for appropriate specialist training post-registration (n=114). To improve physical well-being of service users, the most frequent suggestion was that MHNs should promote healthy lifestyles, e.g. by encouraging physical activity and advising on ways to reduce illicit drug, alcohol and tobacco use (n=152). Responders most frequently cited the need for MHNs to understand resources to support social inclusion (n=110), e.g. knowing how to access local resources, benefits, housing and employment advice. MHNs were most frequently seen as requiring appropriate training to help them support spiritual/religious needs (n=96). CONCLUSIONS: The consultation was successful in obtaining views, in particular, of organisations and groups. These subsequently influenced national recommendations made by the Chief Nursing Officer's Review of Mental Health Nursing.

Attitude of Health Personnel↗

PubMed2006

Segregation--the perspectives of young patients and their parents.

BACKGROUND: Segregation is used increasingly to prevent cross infection, yet little is known about service users' views regarding segregation and its perceived impact. The aim of this study was to elicit patients and carers' views and to involve them in the process of introducing segregation in a paediatric CF centre. METHOD: Open-ended questionnaires were posted to all parents (n=192) and to patients over 10 years (n=101). A content analysis identified common themes. Inter-rater agreement about themes was high (83%). RESULTS: Parents (91%) and children (92%) supported segregated treatment. Parents appeared to be aware of the positive and negative aspects of segregation, and to engage in a balancing act that led them to conclude that segregation was a 'necessary evil'. Children appeared to be less analytical and were concerned mostly with boredom and isolation. Age, level of maturity, and hospital experience were perceived to be determinants of patient adaptation to segregation. CONCLUSION: Segregation has considerable emotional, social, and practical implications for patients and families. Obtaining users' views increased our understanding of the psychosocial consequences of segregation and facilitated its implementation.

Adolescent↗

PubMed2005

A simple imputation algorithm reduced missing data in SF-12 health surveys.

OBJECTIVE: The SF-12 Health Survey is a 12-item questionnaire that yields two summary scores (physical and mental health). Neither score can be computed when an item is missing. We explored imputation methods for missing scores for this instrument. STUDY DESIGN AND SETTING: Using data from a population-based survey, we tested several ways of imputing simulated missing data. RESULTS: Among 1250 participants, 118 (9.6%) had at last one missing SF-12 item. Missing data were more common among women, older respondents, non-Swiss nationals, and health service users. Among the 1132 respondents with complete data, replacement of any item with the mean population item weight yielded good results: the mean correlation between imputed and true score was 0.979 for both the physical and mental score. Results remained satisfactory when up to three of the six key items for each score (items that contribute predominantly to a given score), and any number of non-key items, were replaced by the mean. Application of this imputation algorithm to the original survey reduced the proportion of missing scores to <1%. Respondents with incomplete surveys, hence imputed scores, had lower scores than respondents with complete data (physical score: 44.9 vs. 49.8, p < 0.001, mental score: 44.4 vs. 46.3, p=0.064). CONCLUSIONS: A simple imputation algorithm can substantially reduce the proportion of missing scores for the SF-12 health survey, and consequently reduce non-response bias.

Algorithms↗

PubMed2005

A critical ethnographic study of encounters between midwives and breast-feeding women in postnatal wards in England.

OBJECTIVE: To explore the nature of interactions between midwives and breast-feeding women within postnatal wards. DESIGN: A critical ethnographic study using participant observation and focused interviews. SETTING: Two maternity units in Northern England, UK. PARTICIPANTS: 61 postnatal women and 39 midwives. FINDINGS: The interactions between midwives and women were encompassed by the global theme of 'taking time and touching base'. However, most encounters were characterised by an absence of 'taking time' or 'touching base'. This related to midwives' experiences of temporal pressure and inability to establish relationality with women due to their working patterns. The global theme was underpinned by five organising themes: 'communicating temporal pressure'; 'routines and procedures'; 'disconnected encounters'; 'managing breast feeding'; and 'rationing information'. KEY CONCLUSIONS: The organisational culture within the postnatal wards contributed to midwives experiencing profound temporal pressures and an inability to establish relationality with women. Within this context, the needs of breast-feeding women for emotional, esteem, informational and practical support were largely unmet. IMPLICATIONS FOR PRACTICE: Transformative action is required to dramatically reorganise the provision of hospital-based, postnatal ward midwifery care in parts of the UK. This should include a re-conceptualisation of caring time, with recognition that midwives need sufficient time in order to give time to others. This, in turn, requires recognition that caring time is cyclical and rhythmical, allowing for relationality, sociability, mutuality and reciprocity. The midwifery staffing structure in postnatal wards needs to be reviewed, as it is unacceptable to midwives and service users for staff to be rapidly relocated according to other demands within the institution. Most radically, it is argued that now is the time to reconsider the suitability of the hospital as the place and space within which women commence their breast-feeding journey.

Adolescent↗

PubMed2005

The evolution of social work education in England: a critical review of its connections and commonalities with nurse education.

Social work education in England underwent significant change in its move to degree status in 2003. It is hoped that the result will be increased professional standing for social workers, an improvement in the current widespread problems with recruitment, and assurance that all newly qualified social workers meet the National Occupational Standards for Social Work (Available from: http://www.topssengland.net/files/cd/). This change has pre-occupied social work educators and debate within the profession has concentrated on the practicalities and expectations of reform. This paper suggests that those working in nurse education may observe a number of similarities with its own earlier reforms and with current debates on whether nursing should move to an all-graduate profession. It then highlights three aspects of the new requirements for social work training: service user involvement, the place of research-minded practice, and the primacy of practice--that may be of interest and relevance to nursing colleagues.

Credentialing↗

PubMed2005

Trust and health worker performance: exploring a conceptual framework using South African evidence.

Two relationships of particular importance to health care provision are those between patient and provider, and health worker and employer. This paper presents an analytical framework that establishes the key dimensions of trust within these relationships, and suggests how they may combine in influencing health system responsiveness. The paper then explores the relevance of the framework by using it to analyse case studies of primary care providers in South Africa. The analysis suggests that respectful treatment is the central demand of primary care service users, in terms of positive attitudes/behaviours, thoroughness, and technical competence, as well as institutions that support fair treatment. It is argued that such treatment is necessary for, and integral to, patient-provider trust. The findings also suggest that the notion of workplace trust (combining trust in colleagues, supervisor and employing organisation) has relevance to provider experiences of their workplaces, and so can provide important insights for strengthening management. Nonetheless, given the limitations of this preliminary analysis, further research is needed to develop the notion of workplace trust and to test what role it has, along with that of provider-community relations, in influencing health worker performance.

Efficiency↗

PubMed2006

Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective.

We report a qualitative study of accounts of interpreted consultations in UK primary care. The study sought to explore how three Habermasian tensions between (a) system and lifeworld, (b) communicative and strategic action, and (c) interpersonal and macropolitical spheres played out in the triadic consultation between clinician, interpreter and patient. In a total of 69 individual interviews and two focus groups, we collected narratives from service users (through interpreters or bilingual researchers), interpreters and doctors and other staff in general practice. We recorded, transcribed and analysed these, taking the story as the main unit of analysis. Our data suggest that the preconditions for communicative action are rarely met in the interpreted consultation. The interpreter's presence makes a dyadic interaction into a triad, adding considerable complexity to the social situation and generating operational and technical challenges. Lack of trust, intense pressure of time, mismatch of agendas (biomedical versus lifeworld), firm expectations of a specific outcome (e.g. referral, prescription) and profound power imbalances all promote strategic action (i.e. speech that seeks consciously or unconsciously to manipulate an outcome) rather than communicative action (i.e. sincere efforts to achieve understanding, and reach consensus) by all parties. In consultations interpreted by family members (an option traditionally seen as 'second best' by policy makers), the social situation is very different. Family members are generally trusted, share the lifeworld agenda, and shift the power balance in the patient's favour. The interpreter occupies multiple social roles, including translator, interpersonal mediator, system mediator, educator, advocate, and link worker. The essence of professionalism in interpreting is shifting judiciously between these potentially conflicting roles. We discuss the implications of our findings for communication with limited English speakers in healthcare consultations and for realizing contemporary policy goals such as concordance, shared decision-making, empowerment, and choice.

Communication Barriers↗

PubMed2000

Lesbian, gay and bisexual experiences within critical care nursing, 1988-1998: a survey of the literature.

The aim of this paper is to provide an analysis of the extent to which gay, lesbian and bisexual service user experiences are represented within the critical care literature. A survey of five well established critical care journals, covering the period 1988-1998, was conducted in order to reveal the range of themes addressed within them. The findings suggest that these groups are invisible in this field of practice and consequently their particular concerns have remained marginalised. The implications of this absence are far reaching, potentially inhibiting nurses from establishing effective caring relationships with either lesbians, gays or bisexuals and from identifying and developing appropriate interventions for the care of these patients and their families.

Bibliometrics↗

PubMedDate not supplied

Perceptions of malaria transmission, presentation and management in northern Cameroon.

During early 2001, 1197 adult health service users in a poor rural district of northern Cameroon were interviewed in order to discover prevalent beliefs about malaria. The survey included questions about the name of the disease, its cause and transmission, signs and symptoms, cure, and local importance as a cause of sickness and death. Interviewees showed good understanding of the signs and symptoms of malaria, its importance, and its association with the rains. Most felt that either a medical or a herbal treatment could cure malaria. Only 1% identified mosquitoes as a source of transmission. Health education to explore beliefs and to correct misconceptions should precede and accompany the introduction of technological interventions in malaria control programmes in traditional societies.

Adolescent↗

PubMed2001

[Transdermal nitroglycerin versus corticosteroid infiltration for rotator cuff tendinitis].

AIMS: To compare transdermal nitroglycerin (NTG) and corticosteroid infiltration in patients with rotator cuff tendinitis (RCT). DESIGN: Experimental, randomized controlled study. SETTING: Semirural basic health area in the Garraf region of Barcelona province, Spain, with a population of public health service users of 12000. PATIENTS AND METHODS: Patients diagnosed as having RCT of less than 6 weeks' evolution who had not responded to treatment with oral nonsteroid antiinflammatory drugs. The patients were distributed randomly into two groups: a) group A, local infiltration via a posterior approach with a depot corticosteroid and local anesthesia, and b) group B, treated for 3 days with a 5-mg NTC patch. MAIN MEASURES: Age, sex, pain (measured with an analog visual scale) and adverse events. In patients who showed a partial response, treatment was repeated up to 3 times at 15-day intervals. Pain was tested after 7-10 days of treatment. Complete improvement was considered a reduction in pain of more than 5 points on the analog visual scale; partial improvement was considered a reduction of 3-5 points, and treatment failure was recorded when there was no improvement in pain or when there was a decrease of less than 3 points. RESULTS: A total of 48 patients were included; 33 (69%) were women and 15 (31%) were men. Mean age was 61 years. In group A, complete improvement was seen in 19 patients and partial improvement in 3; treatment failed in 2 patients. In group B complete improvement was seen in 5 patients, partial improvement in 5, and failure of treatment in 14. The difference between groups was statistically significant. Adverse events were mild pain at the injection site in 4 patients from group A, and headache in 15 patients from group B, 8 of whom abandoned treatment for this reason. CONCLUSION: Treatment with NTG is not a clear alternative to infiltration of corticosteroids in patients with RCT, because of its lack of effectiveness and because of the greater number of patients who had adverse events that lead them to abandon treatment.

Analgesics↗

PubMedDate not supplied

[Management of surgical waiting lists by health centers and health professionals].

Waiting lists for non-urgent medical care, in diagnostic or therapeutic procedures, occur mainly in public health systems such as those found in Spain and many other European countries. If waiting lists are moderate they can be useful in the process of managing these patients and are accepted by health professionals and health services users. Waiting lists for surgical procedures can be interpreted, erroneously, as a simple imbalance between the supply and demand for a particular procedure. If that were the case, we would only have to progressively increase resources until eliminating the lists.However, considerable evidence suggests that the isolated increase of resources does not solve the problem since the mean waiting time is reduced but the waiting list becomes longer. Therefore, other management measures are required. The management of waiting lists is necessary at the levels of society, health administration and especially health centers. Clinical management by departments and individual health professionals is essential, using the criteria of inclusion of scientific evidence in the indication for treatment and in the results expected for each patient (effectiveness of the procedure) as well as ethical criteria and considerations of resource use efficiency. Prioritizing patients according to severity, probability of improvement and social criteria is an unavoidable obligation in improving the problem of waiting lists. In this process of prioritization, society should also be able to voice an opinion since non-medical factors may influence the distribution and prioritization of resources and in this context the experience of other countries should be analyzed. Finally, as Archie Cochrane said "all effective treatment should be free" which, put another way would be: in a public system, the financing of procedures that do not provide significant benefits to patients is not justified.

Health Facilities↗

PubMed2003

Discourses of blame: accounting for aggression and violence on an acute mental health inpatient unit.

The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users in the most efficient and effective manner. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings. Traditionally, research in this area has focused on the extent of the phenomenon, the individual characteristics of those involved and precursors to the incident. For the most part the literature reflects a dualistic, perpetrator/victim conceptualisation of incidents. This study aimed to address the lack of research undertaken from a more systemic perspective by examining how all those involved understood and attributed meaning to violent or aggressive situations and how these attributions justified individual perceptions, reactions and actions. Working from the position that all behaviour, including violent behaviour, has meaning to those involved and can be understood, 16 semi-structured interviews were carried out in one mental health unit. Because only one client was both willing and able to give a full account of an incident, we focus here on two incidents in which that client was involved. Discourse analytic techniques were used to examine her account of the two incidents and those of the staff members involved. Participants discussed key themes from the interviews in terms of several dilemmas: whether the violent or aggressive behaviour was 'mad' or 'bad'; predictable or unpredictable; and had resulted from 'personality' or ' mental illness'. The client and staff discourses were strikingly similar and in each case the central concern was with the attribution of blame. The findings have implications for the professional discourse of mental health care, including the discourse of the current policy agenda, a discourse itself constructed with the primary function of exoneration from and attribution of blame.

Adolescent↗

PubMed1998

Perceived risks associated with mental illness: beyond homicide and suicide.

This paper presents an exploratory study of factors of perceived risk related to people who experience serious mental illness. The study focuses upon four stakeholder groups: service users, their carers, mental health professionals and the general public. The development of a questionnaire to examine risk perceptions is described along with the data collection techniques employed in the study. A large number of data sets (n = 1076) was obtained from the four groups of stakeholders (n = 550). Factor analysis of the data produced six factors of perceived risk: underclass, medical disempowerment, threat, vulnerability, self-harm and dependency. This suggests that stakeholders have a wider perception of risk than perceptions defined through current policy. These factors are subsequently examined in relation to a range of independent variables of which gender is the most significant variable in the perception of risk. The findings support results from studies of other forms of risk where women have been found to perceive risks greater than men.

Adult↗

PubMed1998

Probabilities and health risks: a qualitative approach.

Health risks, defined in terms of the probability that an individual will suffer a particular type of adverse health event within a given time period, can be understood as referencing either natural entities or complex patterns of belief which incorporate the observer's values and knowledge, the position adopted in the present paper. The subjectivity inherent in judgements about adversity and time frames can be easily recognised, but social scientists have tended to accept uncritically the objectivity of probability. Most commonly in health risk analysis, the term probability refers to rates established by induction, and so requires the definition of a numerator and denominator. Depending upon their specification, many probabilities may be reasonably postulated for the same event, and individuals may change their risks by deciding to seek or avoid information. These apparent absurdities can be understood if probability is conceptualised as the projection of expectation onto the external world. Probabilities based on induction from observed frequencies provide glimpses of the future at the price of acceptance of the simplifying heuristic that statistics derived from aggregate groups can be validly attributed to individuals within them. The paper illustrates four implications of this conceptualisation of probability with qualitative data from a variety of sources, particularly a study of genetic counselling for pregnant women in a U.K. hospital. Firstly, the official selection of a specific probability heuristic reflects organisational constraints and values as well as predictive optimisation. Secondly, professionals and service users must work to maintain the facticity of an established heuristic in the face of alternatives. Thirdly, individuals, both lay and professional, manage probabilistic information in ways which support their strategic objectives. Fourthly, predictively sub-optimum schema, for example the idea of AIDS as a gay plague, may be selected because they match prevailing social value systems.

Attitude of Health Personnel↗

PubMed2004

Meeting between experts: evaluation of the first UK forum for lay and professional experts in intersex.

At present the clinical management of intersex is in turmoil. The policy of non-disclosure of diagnosis is widespread and cosmetic genital surgery is routinely performed on infants throughout the world. Some clinicians feel such practices are in the interest of the intersex child and the family, but some intersex adults are calling for a moratorium on sex assignment genital surgery. These widely opposing views have led to distrust between groups. One way to begin to address these critical issues is to facilitate dialogue with equal input from clinicians and intersex people and families. Clinicians are experts by training, but patients and families are experts through lived experiences. Our paper reports the rationale, process and outcome of the first UK forum bringing together these different experts to address some of the most complex issues in clinical services. In communicating our experiences, we hope that it will provide a useful reference point for those seeking similar service-user/provider collaboration in other areas of medicine.

Attitude of Health Personnel↗

PubMedDate not supplied

Engagement in meaningful activity and "active support" of people with intellectual disabilities in residential care.

Forty-nine adults with learning disabilities living in 13 small staffed homes in England were studied as part of larger projects in 1997 and again in 2000. A pre-test/post-test comparison group design was used to assess differences in staff implementation of "active support," service user engagement in meaningful activities and adaptive behaviour. Homes which adopted active support showed significantly increased engagement in meaningful activity and adaptive behaviour between 1997 and 2000. A comparison group showed no significant change.

Activities of Daily Living↗