Adherence to Medication Regimen in Patients with Severe and Chronic Psychiatric Disorders: A Qualitative Study

Nonadherence to treatment is common in patients with chronic psychiatric disorders. Few studies have been conducted in Iran on lack of adherence to medication regimen in patients with severe psychiatric disorders. The present study was carried out with the purpose of gaining insight into the experiences of patients, their family members, and nurses on the medication adherence in patients with severe and chronic psychiatric disorders in selected hospitals in Ahvaz, Iran. A qualitative content analysis study was used in the study and the participants included 7 nurses, 5 patients, and 4 family members. The patients were being treated in psychiatric wards of the hospitals of Ahvaz, in southern Iran. The results of data analysis revealed three main themes: 1) Intentional abandonment of medications; 2) Catalysts of medication discontinuation (including side effects, asymptomatic periods, lack of knowledge of family members, and cultural shame of medication use); and 3) Consequences of medication discontinuation. According to the findings of the study, cultural attitudes play an important role in adherence to treatment regimen among the patients with chronic psychiatric disorders. It is recommended to arrange different programs to improve the situation with an emphasis on improving the general attitude of society towards mental illnesses and the need for regular use of the medications.     

Supporting one another: the nature of family work when a young adult has cancer

Families, and the support they provide, are one of the most important resources of the informal health care delivery system As nurses we are called upon to enable clients to maximize their use of family resources and to enable families to cope with illness-related events While research has clearly documented the important role of support in enabling persons to cope effectively with illnesses and illness related events, further research to understand the processes of providing support within families has been called for With such information we may be more effective in our efforts to guide and support families as they cope with illness in a family member This paper was developed from a qualitative study with young adults with cancer that examined social relationships in order to understand the nature of interactions perceived as supportive and the context within which they occurred In-depth interviews conducted with young adults provided detailed data regarding the nature of support young adults received from and offered to their families in order to maintain family functioning The processes of offering and receiving support have been conceptualized into five categories of 'family work' The nature of the work is described and the roles of family members in accomplishing the work are addressed The findings are discussed in relation to current issues in practice     

Gaining control: Family members relate to persons with severe mental illness

Decades of empirical research regarding families of persons with serious mental illnesses has documented the stress and burden associated with the caregiving role. Recent changes in health care delivery have increased responsibilities of family caregivers without appreciably alleviating their stress. The complexities of the caregiving role need to be investigated if effective interventions are to be realized. To date, a critical but understudied area of investigation is the meaning of this experience for family caregivers and how that meaning affects their responses to the caregiving role. The purpose of this interpretive study was to increase understanding of the meaning of caregiving that caregivers derived from ongoing interactions with the ill relative. In-depth interviews were conducted with 15 family caregivers of psychiatric inpatients. Thematic analysis of the textual data revealed that the meaning of caregiving was constituted by the following concerns: finding the essence of the person obscured by the illness, finding a place for self in influencing the illness, and helping the relative to move forward. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 363–373, 1998     

Family members' expectation of the psychiatric healthcare professionals' approach towards them

The importance of involving family members in the care of individuals with schizophrenia or other psychotic illnesses has received increasing attention within psychiatric healthcare services. However, several studies suggest that family members often experience a lack of involvement. Furthermore, research indicates that family members' experience of the professional's approach has bearing on whether they feel involved or not. Thus, the aims of this study were to investigate the level of importance that the family members of individuals with schizophrenia or other psychotic illnesses ascribe to the professionals' approach, the level of agreement between their experiences and what they consider as important, and aspects they consider to be important with regards to contact with professionals. Seventy family members from various parts of Sweden participated. Data were collected by the Family Involvement and Alienation Questionnaire and open-ended questions. The median level and quartiles were used to describe the distribution, and percentage agreement was analysed. Open-ended questions were analysed by qualitative content analysis. The results reveal that the majority of the participants consider Openness, Confirmation, and Cooperation as important aspects of a professional's approach. Continuity emerged as an additional aspect. The results show a low level of agreement between the participants' experience and what they consider as important.     

Outcomes of protocol-based and adaptation-based occupational therapy interventions for low-income elderly persons on a transitional unit.

OBJECTIVES: The study objectives were to describe (a) adaptation trajectories of elderly persons treated on a transitional unit for deconditioning and tracked after their return to the community, (b) an individualized adaptation-based intervention provided to selected elderly persons in addition to protocol-based treatment for deconditioning, (c) goals and outcomes of these two interventions, and (d) contrasting perceptions of outcomes by elderly persons, their family members, and their therapists. METHOD: A longitudinal qualitative design was used to track 8 participants from transitional unit to community. Data on the protocol-based intervention were obtained from chart review and therapist interviews. Data on the adaptation-based intervention were obtained from the Client-Centered Evaluation and Community Adaptive Planning Assessment, which were used for goal setting and problem solving. In the community, contrasting perspectives on outcomes were obtained from the participants, their family members, and their therapists through semistructured interviews. RESULTS: Participants' adaptation trajectories revealed that half relocated to new living arrangements after discharge from the transitional unit. At the time of follow-up, 91% of the protocol-based goals and 100% of the adaptation-based goals had been met in some fashion, with modification in the goal or development of new solutions in some cases. Outcomes valued by the participants were returning to former occupations and relationships; family members valued getting quality care for the participant; and therapists valued improvement in strength, endurance, and increased independence in activities of daily living (ADL). CONCLUSION: Findings support use of an individualized consultative intervention that addresses occupational performance areas and performance contexts combined with a protocol-based, hands-on intervention that addresses performance components and basic ADL for elderly persons with multiple chronic illnesses.     

Views on physician-assisted suicide among family members of Oregon cancer patients

Ninety-eight Oregonians with advanced cancer and their family members participated in a cross-sectional survey to understand agreement in views on physician-assisted suicide (PAS), which was a legal option for these patients. Half of the family members would support the patient's request for PAS, 30% would oppose it, and 19% were undecided. Low religiousness and the family member's personal health concerns were associated with increasing support by the family member for PAS for the patient. Family members were able to predict patients' political views on legalized PAS, and there was moderately high agreement among family members on political views. Family members, however, were not knowledgeable about patients' interest in PAS for themselves, and there was low agreement among dyads on whether they had discussed this issue. Improved knowledge of patient-based barriers to discussing PAS may facilitate interventions for psychosocial distress in cancer patients.     

The search and selection of assisted living facilities by elders and family

BACKGROUND: In this study, we examine factors associated with the search, selection, and satisfaction of residents and family members in assisted living. METHODS: Data were collected from 375 residents of 25 assisted living facilities matched with 375 family members. We conducted face-to-face interviews with the residents to determine: (1) the principal decision maker; (2) the process of searching for a facility; (3) the factors crucial to facility selection; (4) the time frame from the relocation decision to relocation; and (5) satisfaction with selection. Similar questions were asked of family members, using a mail survey. RESULTS: Residents described themselves as extremely influential in 39% of cases when searching for a facility, and in 27% of cases when selecting a facility. Quality, cost, and location were the most influential factors for both residents and family members in selecting a facility. Almost all residents and family would use different search and selection processes if they had to select a facility again, and almost all were dissatisfied with the sources of information available. CONCLUSIONS: Consumers and policy makers both favor the use of assisted living settings; but, the information available to choose a setting is far from ideal, and may represent a barrier to both consumer and policy makers' agendas.     

Transition to parenthood during the transition to modernity in Jordan: New parents' views on family and healthcare support systems

Aims and ObjectivesThis study aims to explore new parents' experiences of family support during their transition to parenthood.BackgroundFamily support is widely considered a crucial factor in contributing toward positive outcomes for parents during transition to parenthood. However, inter-generational and socio-cultural differences among family members in understandings and practices of childcare can be a source of tension between new parents and family members. Few studies have examined the role of family support in the context of rapid social change taking place in Middle Eastern countries. This study aims to address this gap by examining the parenting experiences of young Jordanian couples within the family context they are embedded in.Research Design and MethodsA qualitative study was conducted in Jordan involving sixty semi-structured, in-depth interviews. Twenty mothers, twenty fathers, and twenty family members identified as support providers were interviewed.ResultsThe key theme, “it's too much” emerged from interviews to describe the nature of family support experienced by new parents from marriage to pregnancy and until after the arrival of their first child. The study found varied interpretations of traditional child-care practices among older and younger generation of family members, leading to family conflict. This study also found that the lack of credible information from the health system about child-care compelled them to accept the only available information for them from their parents, often times with much resistance and reluctance. This created a situation of stress and anxiety among young parents and undermined the potential for healthy parenting experience. This study also found that not all social support during early days of parenthood led to beneficial health outcomes to mother and child.”Social visiting” by family members to hospital and home, was particularly found to interfere with new parents' pursuit toward privacy and family bonding, immediately following the birth of child.ConclusionThis study has produced a new understanding of the experience of Jordanian new parents' transition to parenthood. This study particularly sheds light on the current dilemma in which these Jordanian new parents find themselves in, which reflect a clash between traditional and modern values. Although the findings aim to contribute to the body of literature that deals with cultural influences on new parents' experiences in Jordon, the learning could be relevant to the other contexts in the Middle Eastern societies.     

Knowledge of the patient as decision‐making power: staff members' perceptions of interprofessional collaboration in challenging situations in psychiatric inpatient care

Challenging situations in psychiatric inpatient settings call for interprofessional collaboration, but the roles and responsibilities held by members of different professions is unclear. The aim of this study was to describe staff members' perceptions of interprofessional collaboration in the context of challenging situations in psychiatric inpatient care. Prior to the study taking place, ethical approval was granted. Focus group interviews were conducted with 26 physicians, ward managers, psychiatric nurses, and nursing assistants. These interviews were then transcribed and analysed using qualitative content analysis. Results described participants' perceptions of shared responsibilities, profession‐specific responsibilities and professional approaches. In this, recognising knowledge of the patient as decision‐making power was understood to be a recurring theme. This is a delimited qualitative study that reflects the specific working conditions of the participants at the time the study was conducted. The findings suggest that nursing assistants are the most influential professionals due to their closeness to and first‐hand knowledge of patients. The results also point to the possibility of other professionals gaining influence by getting closer to patients and utilising their professional knowledge, thus contributing to a more person‐centred care.     

Disclosing Genetic Test Results to Family Members

PURPOSE: To describe the experiences of disclosing genetic test results to biological family members among people tested for Huntington's disease (HD) or hereditary breast and ovarian cancer (HBOC). DESIGN: Grounded theory methodology. METHODS: Open-ended, tape-recorded interviews were conducted with 29 participants-24 who had received genetic test results and 5 who had decided not to be tested. The participants were from three countries, including 15 U.S. states. Interviews occurred from 2 months to 4 years after receiving test results. Tapes were transcribed and analyzed for conceptual categories to describe the experience of disclosing genetic test results. FINDINGS: Participants described the effects and meaning of disclosing test results to their various family members, and they selectively disclosed results to family members. The timing of disclosure was influenced by the particular disease and the person's perceived need to prepare. Disclosure of genetic test results brought the risk of HD and HBOC to the foreground, not only for the person tested but for family members as well. CONCLUSIONS: This study elucidated the perspective of the "discloser" and the consequences they anticipated and experienced.     

Unidentified communication challenges in the intensive care unit: A qualitative study using multiple triangulations

BackgroundCommunication in the intensive care unit is challenged by patients’ inability to speak owing to intubation, treatment, and illness. Research has focused on the use of communication tools or techniques, characteristics of the communication between patients and clinicians, and their experiences of communication challenges. However, few studies have combined the perspectives of patients, family members, and clinicians. We explored communication from different angles and investigated challenges that cannot be explained by ineffective use of aids and communication techniques.ObjectivesThe aim of this study was to explore communication between patients, family members, and nurses and to investigate previously unidentified communication challenges.MethodsThis study used a case-oriented design with multiple triangulations. It was conducted in two general intensive care units at a Norwegian university hospital. Participant observations were conducted on nine mechanically ventilated patients while communicating with family members and healthcare personnel. Following the observations, individual interviews were conducted with six patients, six family members, and nine healthcare personnel.FindingsCommunication often seemed uncomplicated at the time of observations, but information from the interviews revealed another picture. We demonstrate what participants emphasised differently when they discussed their experiences, revealing a discrepancy in perceived importance in the situation. Family members had an important role in interpreting signs from the patient, uncovering challenges that would have been unknown to the nurses otherwise.ConclusionsThis study illustrates how communication challenges in the intensive care unit may not be perceptible to an observer or to all of the participants involved at the time of the communication. Nurses need to be aware of these communication challenges and realise that the patient might face issues that cannot be easily solved without extensive involvement of the patient, family, and nurses, and perhaps not even until a later stage in the patient's recovery process.     

Exploring health behavior determinants for people with chronic illness using the constructs of planned behavior theory

The theory of planned behavior (TPB) has been successfully applied to various health behaviors. Previous research using this theory has not described the health behaviors of Taiwanese people diagnosed with various different chronic illnesses. Because TPB constructs and determinants are abstract, qualitative interviews were conducted with 36 people with various chronic illness diagnoses to identify such determinants and establish measurement indicators for further quantitative study. Content analysis of responses identified the determinants of attitude affecting adoption of health behaviors, both in terms of encouraging and discouraging adoption. The major referents that influenced health behavior adoption included family members, social networks, and health professionals. The determinants of perceived behavioral control included making health behavior easy and hindering health behavior. These findings provide a new glimpse into the application of the theory of planned behavior on the health behavior of the chronically ill population.     

Coping strategies used by the relatives of people with obsessive-compulsive disorder

BACKGROUND: Obsessive-compulsive disorder (OCD) is a destructive mental illness that alters the lives of both patients and their relatives. Many investigations have described the coping strategies of relatives of patients with schizophrenia, depression and other psychiatric disorders, but there have been no studies reported about coping strategies and OCD. AIM: The aim of this paper is to report an investigation into experiences of burden in relatives of patients with OCD, and the coping strategies they had developed. METHOD: Narrative interviews with 22 family members of patients with OCD were analysed using a grounded theory approach. FINDINGS: Relatives described different burdens and developed different strategies to cope with these. While parents tried to educate their ill children, spouses focused on the patient's resources. The attempts of family members to cope with patients with OCD included assisting in rituals, opposing the symptoms and supporting patients in dealing with the illness. CONCLUSION: Implications for clinical practice to support these relatives are discussed.     

Perceptions of role functions of psychiatric nurse specialists

Specialized and advanced psychiatric nursing practice is an innovative concept in the health care service in Hong Kong. A clear definition of the role and practice of psychiatric clinical nurse specialists (CNS) is important for the development of expert psychiatric nursing practice but is still in a formative stage. A qualitative exploratory study was conducted to identify the psychiatric CNS's perceptions of their role and to compare their perceptions with those of their clinical psychiatric nurse colleagues. The main themes emerging from interviews, observations, and personal diary data were compared and condensed. Eight CNSs and 24 clinical nurse colleagues from acute care and community psychiatric nursing units voluntarily participated in the study. A four-component framework, including clinical practice, organization, education, and professional role, was adopted from nursing literature and used for categorization. The findings showed similarities of role perceptions in the clinical practice, organization, and education components between the CNSs and their nursing colleagues. Differences in role perceptions, concerns about inadequate knowledge and autonomy, and limitations in professional role are discussed.