‘Men just drink more than women. Women have friends to talk to’—Gendered understandings of depression among healthcare professionals and their implications

Little is known about how gendered understandings of patients can inform professionals’ discretionary actions and decisions to include or exclude in clinical practice. Using Connell's poststructuralist perspectives on gender as an analytic framework, this article aims to investigate how professionals’ articulations of depression are framed by signs of masculinity and femininity, and how these articulations inform service provision to patients with depression in clinical psychiatry. Building on interview data drawn from an ethnographic study, the article shows how the professionals’ articulations reflected a gender binary that framed how the feminized patients were often connected to psychiatric care while masculinized patients were referred to separate alcohol or substance use treatment outside the psychiatric institution. The article discusses the societal and institutional conditionality of gendered understandings in psychiatry. In spite of several limitations, the article elucidates how professionals’ understandings might have wide‐ranging implications for the accuracy of epidemiological research and policy, and how they reflect a power struggle between patients and professionals about the legitimate right to interpret patients’ conditions and efforts to manage their illness‐related problems.     

Use of media technology to enhance the learning of student nurses in regards to auditory hallucinations

The aim of this study was to determine if simulation aided by media technology contributes towards an increase in knowledge, empathy, and a change in attitudes in regards to auditory hallucinations for nursing students. A convenience sample of 60 second‐year undergraduate nursing students from an Australian university was invited to be part of the study. A pre–post‐test design was used, with data analysed using a paired samples t‐test to identify pre‐ and post‐changes on nursing students' scores on knowledge of auditory hallucinations. Nine of the 11 questions reported statistically‐significant results. The remaining two questions highlighted knowledge embedded within the curriculum, with therapeutic communication being the core work of mental health nursing. The implications for practice are that simulation aided by media technology increases the knowledge of students in regards to auditory hallucinations.     

Use of Psychiatric Nurse Practitioner Students to Provide Services in Rural School-Based Health Clinics

Seventy to eighty percent of youth receiving mental health services receive these services in schools. Nurses have been identified as the second major provider of mental health services in the schools, yet little has been written about the role of psychiatric mental health nurses in rural school-based clinics or how they were trained in this role. This paper describes an innovative clinical experience for graduate students to shape the role of advanced psychiatric mental health nurses in rural, minority schools using evidence-based approaches. The authors describe the context, theoretical frameworks, role development, outcomes, and lessons learned.     

Working in the real world: a review of sociological concepts of health and well-being and their relation to modern mental health nursing

Since 2008, the world has witnessed several socio-economic upheavals that have fundamentally changed the global economy. Within the UK, these upheavals have coincided with a change in political administration and thus a new approach to managing the volatility of economy. This change has resulted in root and branch reform of service provision that is based around a model that incorporates a shrinking public sector coupled with an increase in civic participation (i.e. 'The Big Society' espoused by the UK-governing coalition). It is also unlikely that healthcare provision on a global level will remain unchanged in such turbulent times. It would therefore seem a useful time to review how socio-economic forces are believed to affect the health and well-being of an individual. These forces include social inequality, the mechanisms of social inclusion and exclusion, social role and the erosion of resilience. This paper will then conclude by offering some potential avenues that nurses can explore to make these forces less damaging for their clients. These avenues include developing a clinical focus based around positive psychology, well-being and some novel ways that nurses can help overcome the maintenance cycles that perpetuate inequality and exclusion.     

Use of primary health care prior to a postpartum psychiatric episode

Objective. Childbirth is a strong trigger of psychiatric episodes. Nevertheless, use of primary care before these episodes is not quantified. The aim was to study the use of general practice in Denmark from two years before to one year after childbirth in women who developed postpartum psychiatric disorders. Design. A matched cohort study was conducted including women who gave birth in the period 1996–2010. Women were divided into four groups: (i) all mothers with postpartum psychiatric episodes 0–3 months after birth, n = 939; 2: All mothers with a postpartum psychiatric episode 3–12 months after birth, n = 1 436; and (iii) two comparison groups of mothers, total n = 6 630 among 320 620 eligible women. Setting. Denmark. Subjects. Women born in Denmark after 1 January 1960, restricting the cohort to women who gave birth to their first singleton child between 1 January 1996 and 20 October 2010. Main outcome measures. The main outcome measures were consultation rates, consultation rate ratios, and rate differences. Results. Women who developed a psychiatric episode after childbirth had higher GP consultation rates before, during, and after the pregnancy. Women with a psychiatric episode 0–3 months postpartum had 6.89 (95% CI 6.60; 7.18) mean number of consultations during pregnancy, corresponding to 1.52 (95% CI 1.22; 1.82) more visits than the comparison group. Conclusion. Women with a postpartum psychiatric episode had higher use of GP-based primary health care services years before the childbirth, and in this specific group of patients childbirth itself triggered a marked increase in the number of GP contacts postpartum.     

A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community

AIMS: The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales. BACKGROUND: Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England. METHODS: A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self-Esteem Scale and General Health Questionnaire GHQ-12. The study was the largest of its kind conducted in the UK. RESULTS: Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption. CONCLUSIONS: These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.     

The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment

This study investigated changes in the ‘atmosphere’ of an acute adult mental health setting following relocation to a new purpose‐built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital‐based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose‐built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less ‘staff control’ in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer ‘involvement’ in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the ‘atmosphere’ of a health facility, for both staff and consumers.     

Use of a mental health guideline by occupational physicians and associations with return to work in workers sick-listed due to common mental disorders: a retrospective cohort study

Abstract

Purpose: The aim of this study was to evaluate (1) whether adherence to the Dutch occupational mental health guideline by occupational physicians was associated with time to return to work in workers sick-listed due to common mental disorders; and (2) whether adherence to specific guideline items was associated with time to return to work.

Methods: Twelve performance indicators were developed to assess occupational physicians’ guideline adherence. Medical records of 114 sick-listed workers were audited. Performance indicators were scored as indicating no (0), minimal (1) or adequate adherence (2). Cox regression analysis was used to assess the association between guideline adherence and first or full return to work.

Results: Guideline adherence was predominantly minimal on most performance indicators. This low overall adherence was not associated with first return to work (Hazard Ratio 1.07, p?=?0.747) or with full return to work (Hazard Ratio 1.25, p?=?0.301). Only one performance indicator (regular contact between occupational physician and employer) was significantly associated with earlier full return to work (Hazard Ratio 1.87, p?=?0.021).

Conclusions: Overall, the guideline adherence of occupational physicians was not related to earlier return to work. However, there was considerable room for improvement in guideline use. Whether this leads to earlier return to work is still an ununanswered question.

• Implications for Rehabilitation

• Adherence of occupational physicians to an evidence-based occupational mental health guideline was low.

• Regular contact between occupational physician and employer was associated with earlier full return to work in workers with common mental disorders.

• It is important to focus on how implementation problems and barriers for guideline use can be overcome, in order to improve the quality of occupational mental health care and to potentially reduce sickness absence duration in workers with common mental disorders.

     

Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice

WAND T, WHITE K and PATCHING J. Nursing Inquiry 2010; 17 : 231–239
Applying a realist(ic) framework to the evaluation of a new model of emergency department based mental health nursing practice Evaluation has become progressively popular within public health and healthcare programme research, with an emphasis on outcomes and a desire to improve practice and service delivery. Mixed methods approaches are consequently being employed to capture the multidimensional characteristics of programmes that aim to address problematic situations affecting targeted populations. This paper provides an overview of critical realism, a modern philosophical perspective that seeks contextualised causal understandings of social phenomena. Realistic evaluation, a research methodology adapted from critical realism, is highlighted as a means of obtaining a deeper appreciation of how complex programmes work, for whom they work, and under what circumstances. The evaluation of a mental health nurse practitioner outpatient service based in the emergency department of a large teaching hospital in Sydney Australia is used to illustrate the application of a realist perspective to research in nursing practice.     

Use of Reading Pen Assistive Technology to Accommodate Post-Secondary Students with Reading Disabilities

ABSTRACT

Reading pens are a form of assistive technology that may be used to bypass weak word decoding and vocabulary skills of students with reading disabilities. Only two known studies have examined the effects of reading pens on the comprehension of school-aged students, and no known studies have been published regarding post-secondary students. The present study investigated the effects of reading pen assistive technology on the comprehension accuracy and rate of three post-secondary students with university-recognized reading disabilities. An alternating treatments design was implemented to compare the effects of (1) a reading pen decoding accommodation, (2) concurrent reading pen decoding and vocabulary accommodations, and (3) a no-accommodation control condition on the comprehension of the three participants when provided college level difficulty reading passages. Results indicate that use of a reading pen did not uniformly improve the comprehension of the post-secondary students. However, the student with the poorest reading skills benefitted the most. Discussion focuses on explanations for the results, practical implications for post-secondary students with reading disabilities, and future directions for study.     

Current Knowledge Related to Intelligence and Thinking With Implications for the Development and Use of Case Studies

PURPOSE. This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. DATA SOURCES. Knowledge from relevant literature sources was summarized. DATA SYNTHESIS. The provision of high‐quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses’ expertise. CONCLUSIONS. Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. IMPLICATIONS. The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.     

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study

Purpose: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.

Materials and methods: Semi-structured interviews with 15?line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.

Results: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.

Conclusion: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment.

• Implication for rehabilitation

• Organizations should aim to provide support for line managers handling the return to work process.

• Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process.

• Research-based knowledge and guidelines on work-related stress and return to work are essential.

• A common and formal definition of stress should be emphasized in the workplace.

     

Use of a clinical decision support system to increase osteoporosis screening

Background In 2002, the US Preventive Services Task Force recommended routine osteoporosis screening for women aged 65 years or older. However, studies have indicated that osteoporosis remains underdiagnosed, and various methods such as the use of health information technology have been tried to increase screening rates. We investigated whether we could boost the low rates of bone mineral density testing with implementation of a point‐of‐care clinical decision support system in our primary care practice. Methods We retrospectively reviewed the medical records of female patients eligible for osteoporosis screening who had no prior bone mineral density test who were seen at our primary care practice sites in 2007 or 2008 (before and after implementation of a point‐of‐care clinical decision support system). Results Overall, screening rates were 80.1% in 2007 and 84.1% in 2008 (P < 0.001). Of patients who did not have osteoporosis screening before the visit, 5.87% completed the screening after the visit in 2007, compared with 9.79% in 2008 (when the clinical support system was implemented), a 66.7% improvement (P = 0.025). Conclusion Clinical decision support for primary care doctors significantly improved osteoporosis screening rates among eligible women. Carefully designed clinical decision support systems can optimize care delivery, ensuring that important preventive services such as osteoporosis screening for patients at risk for fracture are performed while unnecessary testing is avoided.