Addressing physical health problems experienced by people with schizophrenia in Canada: a critical literature review

The authors present a critical review of the literature produced by Canadian researchers regarding medical co-morbidities and the resources and strategies they recommend for assessing and managing the physical health problems of people with schizophrenia. Scientific production in the field consists of 9 original research articles and 6 literature reviews, revealing a dearth of studies in this area in Canada. The studies examined show that diabetes, obesity, heart disease, and substance abuse are the most frequent co-morbidities affecting people with schizophrenia. Another finding is that most researchers are challenged methodologically to generalize results due to limitations in design or sample characteristics. The authors point to the need for more research to better understand the role of treatment, individual characteristics, lifestyle, and structural issues in the development of co-morbidities among people with schizophrenia. They also discuss the importance of addressing these topics in nursing practice and education.     

Improving the physical health of people with severe mental illness: Boundaries of care provision

There is compelling evidence that the physical health of people with severe mental illness is poor. Health‐promotion guidelines have been recommended as a mechanism for improving the physical health of this population. However, there are significant barriers to the adoption of evidence‐based guidelines in practice. The purpose of this research was to apply existing implementation theories to examine the capability of the health system to integrate physical health promotion into mental health service delivery. Data were collected within a regional city in Queensland, Australia. Fifty participants were interviewed. The core theme that emerged from the data was that of ‘care boundaries’ that influenced the likelihood of guidelines being implemented. Boundaries existed around the illness, care provision processes, sectors, the health‐care system, and society. These multilevel boundaries, combined with participants' ways of responding to them, impacted on capability (i.e. the ability to integrate physical health promotion into existing practices). Participants who were able to identify strategies to mediate these boundaries were better positioned to engage with physical health‐promotion practice. Thus, the implementation of evidence‐based guidelines depended heavily on the capability of the workforce to develop and adopt boundary‐mediating strategies.     

Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists

Both New Zealand and Sweden have health and disability policies that promote recreational exercise within society for people with disability. Despite these policies, levels of physical activity by people with disability in these countries are low. Physiotherapists are equipped to assist people with disabling conditions into physical activity. This qualitative study explored the perspectives and experiences of physiotherapists in New Zealand and Sweden toward promoting physically active recreation for adults with chronic neurological conditions. Nine physiotherapists who worked with adults with neurological disability in a range of long-term rehabilitation and community (home) health services were interviewed and the data analysed for themes. The physiotherapists described innovative and resourceful expertise to assist patients to be physically active. However, they perceived a lack of support for their work from within the health system and a lack of knowledge of disability issues within the recreational arena, both of which they perceived hindered their promotion of physical activity for people with neurological disability. Physiotherapists feel unable to fully support health and disability policies for the promotion of physically active recreation for people with neurological conditions, because of perceived constraints from within the recreational arena and their own health systems. If these constraints were addressed, then physiotherapists could be better agents to promote physical activity for people with neurological conditions.     

Addressing the mental health needs of people with learning disabilities

It is now common policy in providing care for people with learning disabilities to ensure improved access to mainstream health services. Consequently, all nursing disciplines are required to have improved understanding about the physical and mental health needs of this client group. This article focuses on their mental health needs. It is predominantly targeted at mental health and learning disability nurses, but will be of interest to all nurses who increasingly come into contact with people with a learning disability and require insight into all aspects of their health.     

Evolving role of mental health nurses in the physical health care of people with serious mental health illness

Life expectancy in members of the general population has steadily improved in most countries since 1960. However, during the same period, the life expectancy of people with serious mental illness (SMI) has actually reduced. The majority of premature deaths result from natural causes, such as coronary heart disease. Obesity, a key risk factor for heart disease in this client group, might be caused both by unhealthy lifestyle behaviours and the side-effects of antipsychotic medication. Mental health nurses (MHN) nurses have an important role to play in improving the physical health of people with SMI. Evidence, however, suggests that they are often ambivalent about this role, and might perceive themselves as being inadequately trained and lacking in confidence. In this paper, we will argue that MHN need to re-evaluate their practice and recognize that the provision of physical health care is as important as other roles they occupy in relation to the care of people with SMI. We will also consider examples of best practice in physical health care, and discuss how these might be adopted by MHN and other professionals, in order to begin to improve services and to reduce health inequalities in this client group.     

Cardiometabolic effects of physical activity interventions for people with schizophrenia

Abstract

Objectives: To identify and evaluate the recent evidence of physical activity (PA) with or without diet counselling on cardiometabolic parameters in people who have schizophrenia.

Methods: Keyword searches were used to identify articles since 2003 up to August 2009 from PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, EMBASE, PEDro, DARE, ProQuest Dissertations and Theses and PsycINFO. There were no limitations in terms of study design and sample size. Data were extracted from each included study using key items that included participants, study design, intervention modalities, and outcome measures.

Results: Thirteen studies met the inclusion criteria. Physical activity with or without diet counselling results in modest weight loss, reductions in systolic and diastolic blood pressure and decreases in fasting plasma concentrations of glucose and insulin. Identifying an optimal dose or intervention strategy for PA is not yet possible. Compliance to PA seems to be an important predictor of the PA response.

Discussion: There is evidence that PA with or without diet counselling is feasible and effective in reducing weight and improving obesity-related cardiometabolic risk profile in people with schizophrenia. More research focussing on the effectiveness of different PA interventions in prevention and treatment of the metabolic syndrome in people with schizophrenia is highly needed.     

The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory

Aim and objectives. The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design. Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods. Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi‐structured one‐to‐one in‐depth interviews and unstructured non‐participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results. A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion. In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice. The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.     

Insight into schizophrenia: planning mental health service provision for schizophrenia using a brief psychological intervention

Six nurses were trained to deliver an Insight programme to patients with schizophrenia and their main carers. One outcome of the intervention was the highlighting of recommendations for future treatment. These were fed back on an individual basis through an exit letter to the patient's consultant psychiatrist and key worker. The individual treatment recommendations were then collated into a report for each site and presented to clinical coordinators and business managers. It is envisaged that the recommendations could be used by managers in developing a business case for future mental health provision in schizophrenia. The complete results of the study are due to be published in the near future.     

Loneliness in elderly people: an important area for nursing research

The phenomenon of loneliness occurs in people of all ages but may be a particular problem in the elderly It is acknowledged that loneliness is not a necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in elderly people However, there is a relationship between ageing and loneliness Four major theories of loneliness are reviewed and their utility for application to research in the elderly is examined along with a consideration of the ways in which loneliness can be measured While causal relationships are difficult to determine, there is evidence that loneliness is associated with a number of physical and psychological pathologies and the relevance of these to nursing is discussed There is a growing awareness of the phenomenon of loneliness in elderly people in the nursing literature and some evidence that nursing intervention can be beneficial in this regard both at alleviating loneliness and reducing some of the adverse effects of loneliness Finally some directions for nursing research are presented which are aimed at improving the assessment and nursing intervention for loneliness in elderly people     

Mental health practitioner's attitude towards maintenance neuroleptic treatment for people with schizophrenia

Pharmacological relapse prevention treatment for people with schizophrenia can last for years if not the person's lifetime. The attitude mental health practitioners (MHPs) hold regarding this treatment can have profound effects on service users' decisions related to treatment. The small number of studies focusing on this issue concentrates on the use of 'depot' preparations. To develop a validated inventory to assess the attitudes of MHPs towards treatment and evaluate the attitudes of a sample of MHPs. The inventory was developed in three stages; item selection, piloting and psychometric testing. The validated inventory was administered to a sample of 50 MHPs undertaking a degree level course in the psycho-social management of psychosis. The final inventory consisted of 21 attitudinal items and four items related to the practitioner's confidence. Results from the sample revealed areas of agreement, variation and uncertainty. A valid and reliable inventory has been developed. The administration of the inventory to 50 MHPs returned results which reflect variable attitudes and perceptions of competency towards maintenance neuroleptic treatment. This diversity in attitudes may have an impact on management of people with a diagnosis of schizophrenia and clinical outcomes.     

Paediatric pain: an important area for research in physical therapy

Abstract

Pain and pain management are topics for which there is an abundance of literature available, including research on pharmacological and non-pharmacological management of acute and chronic pain. However, the amount of information available dwindles significantly when the topic turns to pain in the paediatric population, and is even more limited in regard to nonpharmacologic management of such pain.     

Exploring the benefits of an exercise program for people with schizophrenia: a qualitative study

The relationship between regular exercise and physical health and well-being is extensively documented in the literature. However, considerably less attention is devoted to the impact of exercise on health outcomes for people experiencing a mental illness. In response to the recognized paucity, a structured exercise program was developed and implemented for residents of a Community Care Unit in metropolitan Melbourne, Australia. Six residents participated in the program over a period of three months. This paper reports the findings of a qualitative study. A focus group interview was conducted with the resident participants (n=6), the exercise physiologists who developed and implemented the program (n=2), and nursing staff involved in implementing and supporting the program (n=4). Analysis of the data collected revealed that four main themes had emerged: the individual nature of the program, physical improvement, group dynamics, and future plans. The findings of this study suggest that involvement in the program produced very positive outcomes, most notably in the physical fitness of residents. The individual nature of the program which enabled gradual participation, and the cohesive approach of the group as a whole were considered very important factors contributing to the overall success. Furthermore, the participants planned to continue with some form of physical activity in the future. The potential value of regular exercise for patients experiencing a mental illness has significant implications for nursing and requires further research exploration.     

Antidepressants: clinical guidance of treatment for people with depression and physical health problems

Current management in primary care of depression with comorbid physical illness is considered suboptimal. Detection and management of depression is somewhat complex. In particular, primary care clinicians need guidance to address the social needs of depressed patients. This review for clinical physicians provides guidance how to treat those patients with depression in particular at primary care settings. The viewpoints of clinical use of newer antidepressants including SSRIs and SNRIs are described. Given that depression would affect the outcome of physical illness, managing depressed people with comorbid physical illness is very important and understanding relevant drug treatment for depression is essential for primary care physicians.     

Influencing factors of community mental health nurses caring for people with schizophrenia in Taiwan

The purpose of this study was to explore the influencing factors in the substantive theory of home care for people with schizophrenia in Taiwan. The grounded theory of Strauss and Corbin approach was used. Semi-structured one-to-one in-depth interviews were utilized to collect data. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected using theoretical sampling, and the final sample in this study consisted of a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home-visiting services. The public health nurses and home health nurses both conducted a total of 16 (eight carers and eight clients) home visits. Four categories and 12 subcategories of influencing factors were identified; these factors have both positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. The influencing factors identified support the importance of home care services.     

Addressing Internet training issues for people with Parkinson's disease

The Internet enables access to information, services, support and participation in leisure opportunities. Some populations, including people with disabilities, lack access to these opportunities through the Internet. Barriers may include finances, physical access, lack of resources and inaccessible websites. Limited access to Internet training is an additional barrier for people with communication impairments. People with Parkinson's disease (PD) may have difficulty accessing usual Internet training due to high-level language, cognitive and physical limitations. Aphasia-friendly Internet training materials were trialed with this population to investigate if participants could learn to use the Internet and would benefit from Internet training. The tutors' experience was also investigated using qualitative measures. Seven people with PD were matched with volunteer tutors. These pairs met for six Internet training lessons using training materials available as a free download from: http://dexter.shrs.uq.edu.au/cdaru/aphasiagroups/. Pre and post-test Internet skills assessments and attitudinal questionnaires were conducted. Significant differences between pre and post-test scores were found. Participants reached varying levels of independence on Internet tasks. Favorable outcomes were reported by participants, and tutors reported a positive experience. Further investigation is recommended to determine the efficacy of this approach compared with other training avenues and with other communication-impaired populations. Practical and theoretical implications for speech pathology practice are discussed.     

Towards improving health care delivery for people with physical disabilities: findings from focus groups with health care consumers in Minnesota

Specialized managed care programs such as the MnDHO program can improve the health care experience for people with disabilities if they include seamless care coordination among disability competent providers and promote consumer participation. Findings indicate greater satisfaction with care coordination, consumer participation, and provider knowledge in the AXIS/UCare complete program.