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PubMed2003

Researching nursing practice: does person-centredness matter?

Person-centredness is common speak in nursing and health care literature. Increasingly there is an expectation that practitioners adopt person-centred principles in their practice and organizations are expected to respect the values of the service user. However, in the research methodology literature, there is little explicit attention paid to the concept of person-centredness in research practice. Instead, there continues to be a reliance on traditional 'ethical principles' to guide effectiveness in research work. This paper argues that the principles of person-centredness that are espoused in nursing practice should also underpin nursing and health care research. A framework for person-centred research is proposed and issues concerning its implementation in practice are discussed.

Humans↗

PubMed2001

Personal view: Randomized controlled trials in epilepsy specialist nursing: the seduction of content by form.

Research into the effectiveness of epilepsy specialist nursing needs to take into account a number of factors, which have not been adequately addressed in previous studies. Nursing outcome measures are different to medical ones and it is inappropriate to confuse these. Specialist nurses affect the whole culture of a service, and their impact on service quality may go beyond that of their individual patient contacts. Thus randomized studies within a service that already has specialist nurses may not give valid results. Some service users will benefit more from direct contact with a specialist nurse than others, and people who give informed consent to take part in randomized controlled trials might not be representative of those who would benefit most from specialist nurse access. The stampede for level one evidence risks failing to address the issues properly by overvaluing research process (form) against its appropriateness (content), yet there remain great opportunities for good quality research in this area.

Epilepsy↗

PubMed2002

Use of traditional medicine in Mongolia: a survey.

OBJECTIVES: To conduct a pilot investigation of the frequency with which individuals visit practitioners of Western and traditional Mongolian medicine and their motivations for making these visits. DESIGN: Survey based interviews were conducted in a sample of 90 adults. SETTING: Darkhan, Mongolia. MAIN OUTCOME MEASURES: Measures included the annual frequency of visits to practitioners of traditional and Western medicine as well as ratings of the importance of seven factors in choosing what type of practitioner to use. RESULTS: During the past year, 51% of subjects interviewed had used Western services exclusively, 8% had used traditional services exclusively, and 38% had used both types of services. Users and non-users of traditional medicine did not vary in terms of age, gender, occupation or rural vs urban residence. Traditional medicine users rated the knowledge base of traditional practitioners higher than did nonusers (5.3/7 vs 4.5/7, P < 0.01). A patient's specific illness appears to be important in deciding what type of treatment he will seek. CONCLUSIONS: Traditional medicine appears to be a more significant component of Mongolian health care than is reported in the international literature and consequently may deserve additional attention in future studies of the country's medical system.

Adult↗

PubMed2000

Caring for women: the potential contribution of formal theory to midwifery practice.

OBJECTIVE: To explore the interpretations midwives and nurses attach to the concept of caring, how caring values are manifest clinically and might be encouraged educationally. DESIGN: Ethnographic fieldwork was undertaken in UK National Health Service palliative and maternity-care hospital settings for 12 and 10 days respectively. This involved non-participant observation, semi-structured, audio-taped interviews with seven midwives and six nurses. Ad hoc conversations with service-users were also undertaken and contextual information, such as staffing levels, was collected. The data were thematically analysed against a conceptualisation of caring developed from nursing and philosophical literature. FINDINGS: Comparison of observational and interview data across the settings identified qualitative differences in care delivery. In the palliative care setting, practice was other-centred, receptive, responsive and attentive to the patient's person and experience. In comparison, caring values appeared eroded in the maternity setting, where practice was often routinised, task-orientated and, on occasions, unresponsive to women's needs. Features existed in the palliative care setting which appeared instrumental in facilitating a caring practice culture. In particular, clinical leaders facilitated team cohesion through daily 'debrief' meetings and care enhancement against theoretical frameworks. These encompassed caring values and provided the source of problem identification and remedial strategy. No such collective, theoretical perspectives were evident in the maternity setting. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Whilst acknowledging the limitations of formal theory, it is suggested that midwifery goals and priorities of care could be utilised to theoretically frame, critically evaluate and guide practice. This has the potential to heighten awareness of care deficits and enable midwives to work collectively to enhance women's experience of childbirth at both clinical and political levels.

Empathy↗

PubMed2003

[Madhouse, asylum, retreat, specialist hospital - on the genesis and history of names for psychiatric institutions in Germany until the beginning of the 20th century].

This paper analyses the history of names for psychiatric institutions in the German language. When scientific, medical psychiatry came into being in the late 18 (th) century, names with negative connotations such as "Narrenhaus" or "Tollhaus" (approximating to the English word "madhouse") were substituted by the then neutral "Irrenhaus" and later in the 19 (th) century by "Irrenanstalt". Soon, however, this new term became associated with negative connotations, making it unsuitable as a reflection of the many improvements made both in the treatment and the public image of psychiatric service users. Changes in word form such as "Heilanstalt", "Pflegeanstalt" and "Heil- und Pflegeanstalt" better reflect the character of the institutions. Objections to the word "Anstalt" (institution) were not acknowledged until the 20 (th) century when the term "Fachkrankenhaus" ("specialist hospital") was introduced. Before then the German word "Klinik" was reserved for university hospitals, the first of which was founded in 1878. The history of names for psychiatric institutions reflects both changes in the treatment of the mentally ill and the attempts made above all by psychiatrists to face and overcome stigmatisation of their clients.

Germany↗

PubMed2001

Development of a brief form of the Life Skills Profile: the LSP-20.

OBJECTIVE: To develop a brief form of the Life Skills Profile (LSP) that incorporates all five subscales of the full form. METHOD: A new short form of the LSP (LSP-20) was developed to incorporate all five subscales of the full form. The LSP-20 development was based on a reanalysis of data from previously published studies. These data sets were also reanalysed to determine any differential effects of numbers and percentages of items in the LSP-39, LSP-16 and LSP-20, comparability of scores of the different forms, of test-retest and interrater reliability, and validity of the LSP-20 by comparison with the Positive and Negative Syndrome Scale (PANSS). RESULTS: A twenty-item short form of the LSP-39 (LSP-20) is described which retains 16 items of an earlier short form but which also reproduces the subscale concerned with disability associated with positive psychotic phenomena. The subscales correlated highly with their counterparts in the full form, interrater and test-retest reliabilities were comparable, and concurrent validity was good. CONCLUSIONS: The LSP-20 is a brief form of a widely used instrument that offers equivalent coverage to the full form with sound empirical properties, though unlike the LSP-39, it can be scored in the direction of impairments or strengths. Therefore the LSP-20 may be more suited to routine service disability and aggregated outcome assessments, but less suited than the LSP-39 to detailed research, or to interactive use as part of service user's individual care planning and review.

Adult↗

PubMed1979

Prediction of symptoms and illness behaviour from measures of life change and verbalized depressive themes.

A new measure of depressiveness in speech content and the Schedule of Recent Experiences are used to predict illness reports and clinic use in two samples of subjects. The results suggest that the more life change the subjects reported, the more depressiveness they verbalized, and that both life change and depressiveness scores predict illness reports and health service users. Multivariate combinations of the measures of life change and depressivenss gave better predictions than either measure alone, and the measure of depressiveness for the most part gave somewhat better predictions than the life change measure. This suggest that it is important to quantify reactions to life events. In addition, it suggests that the two longstanding currents of interest in psychosomatic medicine which concern the importance of life events on the one hand and of affective and intrapsychic events on the other can profitably be integrated.

Adolescent↗

PubMed2005

The language of cutting: initial reflections on a study of the experiences of self-injury in a group of women and nurses.

Non-suicidal self-injury is a distressing act, which can arouse dissent and negative comment in service users and providers. The purpose of the study was to describe how women who self-injure and nurses assign meaning to shared discourses about self-injury. The wider study is framed in a grounded theory methodology. Fourteen qualified nurses and 11 women who have self-injured were interviewed using unstructured and initially open-ended interviews, lasting 45-90 minutes. Initially a thematic analysis was used to code data. In this report, three of the early themes are reported with some comparative interpretations. Nurses lack understanding of the meanings of cutting behaviour. A common language is needed if nurses are to be effective in helping women who have self-injured to express distress in less damaging ways.

Attitude of Health Personnel↗

PubMedDate not supplied

Medicine, gender, and disability: disabled women's health care encounters.

In this article I examine the intersection of gender and disability in the medical arena by considering disabled women's experiences of receiving health care in the United Kingdom. Drawing on the "social model of disability," I focus on the attitudes and practices of doctors. I use two sources of qualitative data: (i) 68 disabled women's narratives gathered in the United Kingdom in 1996-1997; (ii) interviews with 17 disabled women regarding their reproductive experiences in the United Kingdom. I suggest that disabled women health service users are at risk of experiencing oppressive medical practices because two forces of oppression appear to be frequently, and interactively, in play: patriarchy and disablism.

Attitude of Health Personnel↗

PubMedDate not supplied

Strategies of social and sexual control of Malaysian women in psychiatric institutional care.

An ethnographic study of female psychiatric patients was undertaken in East Malaysia. Findings indicate that these service users were subject to a number of sexist and oppressive practices that militate against their freedom of movement on the wards as well as their social interaction in the wider context of the hospital. Stereotypic notions of female sexuality and morality act as forms of moral containment and are interpreted in the hospital context as requiring heavy custodial care by the hospital authorities.

Anecdotes as Topic↗

PubMed1990

Two-month follow-up on callers to a telephone quit smoking service.

The results of a 2-month follow-up on a sample of individuals who rang a telephone quit smoking service to get advice on how to quit smoking are reported. Calls were in response to large-scale media campaigns carried out in Victoria each year from 1984 through 1986. The calls to the service came more from women than men and tended to come from better educated white collar workers. There were few differences in short-term quit rates as a function of basic demographic variables. There was some evidence that after 3 years of campaigning a greater proportion of telephone service users were making a major effort to quit and that younger smokers at whom the campaign was directed were more likely to quit.

Journal Article↗

PubMed2006

The national continuous quality improvement tool for mental health education: results of targeted and supported implementation in England.

The national continuous quality assurance tool for mental health education and training has recently been developed. This paper describes the planned implementation of the tool across NHS Workforce Development Confederations (WDCs) in England. Large stakeholder groups in 15 WDCS were convened. The groups rated 29 programmes across a range of provisions including pre-qualifying programmes (social work and mental health nursing), post-qualifying programmes, new graduate mental health worker programmes and programmes run within NHS Trusts. Overall, the results indicate that the majority of rated programmes are relevant to the policy agenda and involve service users in a meaningful way. However, courses are less likely to engage with carers and to assess the impact of the programmes. Key factors are identified that promote the implementation of the new quality assurance tool and key barriers to implementation are also elicited. The paper concludes that the tool can provide a useful framework to assess the quality of a broad range of mental health education, furthermore, that it should be incorporated into existing quality assurance systems.

Curriculum↗

PubMed2006

Leadership in interprofessional collaboration - the case of childcare in Norway.

This study addresses leadership in interprofessional collaboration in childcare services (residential care). The aim was to explore the managers' (n = 6) experiences and present their views on how they exercised leadership in the residential institutions as well as how they organized and facilitated collaboration with relevant professionals and service users. Data was collected through open interviews. Qualitative content analysis was used to analyse the interviews, and three categories emerged; "external responsibility", "sustaining communication" and "internal responsibility". The overarching concept was identified as "facilitating interaction processes and ensuring cohesion". The main findings were related to the managers' experiences of linked processes of leadership and collaboration, perceptions of the structures of communication, their responsibility as well as the interaction processes. The managers exercised leadership in terms of self-governance and co-governance, and used strategies, such as governing images and influencing the voluntary aspect of collaboration.

Administrative Personnel↗

PubMed2006

Prevalence of hearing loss in 1598 adults with an intellectual disability: cross-sectional population based study.

A cross-sectional epidemiological study on prevalence of hearing loss was carried out in an age- and Down's syndrome- stratified random sample of 1598 persons drawn from a base population of 9012 persons, representative of the Dutch adult population of intellectual disability (ID) service users. The re-weighted population prevalence is 30.3% (95% confidence interval [CI]: 27.7-33.0%). Subgroup prevalences range from 7.5% (95% confidence interval [CI]: 3.6-13.3) in the subgroup aged 18-30 years with ID by other causes than Down's syndrome, up to 100% (95% CI: 79.4-100%) in adults over 60 years of age with Down's syndrome. Down's syndrome (OR 5.18, 95% CI 3.80-7.07) and age were confirmed to be risk factors. Age-related increase in prevalence in persons with Down's syndrome appears to occur approximately three decades earlier, and in persons with ID by other causes approximately one decade earlier than in the general population.

Adult↗

PubMed1994

Perceptions and knowledge of stroke among surviving patients with stroke and their carers.

As part of a survey to collect data which would be useful in planning a district stroke service we set out to discover what the service users' (patients' and carers') perceptions and knowledge of their illness were. We prospectively identified 164 consecutive patients with acute stroke admitted to hospital. Of the 110 (67%) survivors 65 (59%) patients and 80 (73%) carers completed a semi-structured interview. Most (46, 71%) patients and (68, 85%) carers thought they understood what a stroke was but 14 (22%) patients and 12 (15%) carers did not differentiate between a 'stroke' and a 'heart attack'. Carers were significantly more likely than patients to want know all the details about the patients' condition and treatment, to discuss the risk of recurrence, to receive written information and to join information groups. They were more likely than patients to feel that they had to ask for information, yet they were better able to identify general risk factors for stroke. Many patients and carers want more information and discussion about their illness and treatment during their hospital stay, however, some do not. Therefore information giving must be considered on an individual basis. Information could be delivered by: increasing available literature, voluntary group meetings, Stroke Family Care Officers and audio-visual information packages. The most efficient way of achieving an increased understanding amongst patients and carers needs to be found.

Acute Disease↗

PubMed2001

A stakeholder approach towards hospital accreditation in India.

Accreditation has been recommended as a mechanism for assuring the quality of private sector health services in low-income countries, especially where regulatory systems are weak. A survey was conducted in Mumbai, India, in 1997-98 to elicit the views of the principal stakeholders on the introduction of accreditation and what form it should take. There was a high level of support for the classical features: voluntary participation, a standards-based approach to assessing hospital performance, periodic external assessment by health professionals, and the introduction of quality assurance measures to assist hospitals in meeting these standards. Hospital owners, professional bodies and government officials all saw potential - though different - advantages in accreditation: for owners and professionals it could give them a competitive edge in a crowded market, while government officials reckoned it could increase their influence over an unregulated private market. Areas of disagreement emerged; for example, hospital owners were opposed to government or third party payment bodies having a dominant role in running an accreditation system. The growing strength of a health service user representative lobby in Mumbai is an additional reason why this would be a suitable place for piloting such a system. The biggest obstacle to introducing accreditation in poorly resourced settings, such as India, is in how to finance it. The provisional support of the principal stakeholders for such a development, demonstrated in this study, will require a commitment from government and policymakers if the potential benefits of accreditation to the health of the population are to be realised.

Accreditation↗

PubMed2002

Prescribing welfare benefits advice in primary care: is it a health intervention, and if so, what sort?

There is increasing provision of welfare benefits advice in primary care (WBAPC). This reflects the present government's recognition of the association between socioeconomic and health inequalities. However, the assumption that increasing an individual's income will improve their health is not based on clear evidence. This paper reviews the relevant evidence, using four categories of pathways from poverty to ill-health: individual material; environmental material; individual psychological; environmental psychological. A description is offered of the scope and limits of WBAPC as a health intervention: one that primarily offers relief from psychological stress for service users, who tend to be middle-aged or older and suffering from chronic disease or disability. WBAPC may also make a small contribution to the physical health of individuals and to the social capital of communities. Thus to define the scope of WBAPC does not diminish its value to its beneficiaries, who carry a significant burden of both poverty and illness, nor does it in any way weaken the ethical argument for public policy to seek to reduce inequalities, and for primary care to play its part in that.

Cost of Illness↗

PubMed2006

Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.

Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

Affect↗