Needs and unmet needs for rehabilitation services: a scoping review

Background: There is a global demand for rehabilitation services but to date little attention has been paid to rehabilitation as part of the health agenda, especially in low- and middle-income countries. The objective of the scoping review was to get an overview of the needs and unmet needs for rehabilitation services described in the literature.

Materials and methods: Electronic search was performed in PubMed and REHABDATA for studies published between 2000 and 2017.

Results: Eighty-six articles met the inclusion criteria. Results revealed a profound need for rehabilitation among different user groups with non-communicable diseases and injuries across countries. However, this need considerably outstripped the provision of services, which left many people with substantial unmet needs for rehabilitation. The main reasons for the unmet needs for rehabilitation were the absence of or unequal geographical distribution of services within a country, lack of transportation, and unaffordability of the services.

Conclusions: There are substantial unmet needs for rehabilitation and numerous barriers to accessing services. Efforts need to focus on building the capacity for rehabilitation research predominantly in low- and middle-income countries. The comprehensive data that this review provides is useful for raising awareness for the need of rehabilitation at policy level.

• Implications for rehabilitation

• There is a profound need for rehabilitation services due to the ageing population and growing prevalence of non-communicable diseases.

• This scoping review shows that the need for rehabilitation considerably outstrips the provision of services.

• There are substantial unmet needs for rehabilitation and numerous barriers to accessing services.

• Concerted global action to scale up quality rehabilitation services is needed, especially in low- and middle-income countries.

     

首发精神障碍家庭照顾者经历的系统评价

目的：系统评价首发精神障碍家庭照顾者的经历,为患者早期康复及照顾者心理健康问题的干预提供循证依据。方法：计算机检索The Cochrane Library、Ovid、PubMed、Embase、Web of Science、CBM、CNKI、VIP和WANFANG DATE数据库,检索时限均从建库至2021年7月31日,使用“JBI循证卫生保健中心质性研究质量评价标准”评价符合纳入标准的文献,并采用汇集性整合法对研究结果进行整合。结果：纳入12篇文献,提炼出60个研究结果,整理成8个类别,得出3个整合结果。分别是多维度的挑战、成长或缺如的角色结局、急需的社会支持。结论：亟需提高全民心理健康素质及去精神障碍疾病污名化,营造患者及家属无障碍化就医环境;关注家庭照顾者早期心理健康的干预,满足其社会支持的需要,提高该类人群应激应对能力,促进照顾者心理康复。     

A controlled trial of a needs‐based,nurse‐led psychoeducation programme for Chinese patients with first‐onset mental disorders: 6 month follow up

The study reported herein a randomized controlled trial was conducted to test the effectiveness of a nurse‐led, needs‐based psycho‐education program for Chinese patients with first‐onset mental illness over a 6‐month follow‐up. Ninety‐six families of Chinese patients with schizophrenia newly referred to one outpatient clinic in Hong Kong were randomly assigned to a nurse‐led psycho‐education program or usual outpatient care, each comprising 48 subjects. The patients’ mental health, illness insight, self‐efficacy, services utilization, and hospitalization rates were measured at recruitment and at one week and six months post‐intervention. The patients in the psycho‐education program reported significantly greater improvements in mental health, insights into treatment and illness, and hospitalization rates over the 6‐month follow‐up, when compared with those who received usual care. The findings provide evidence that the needs‐based, nurse‐led psycho‐education program can improve the health conditions and treatment insights of Chinese out‐patients with first‐onset mental illness.     

Clinical nursing competency assessment: a scoping review

Objective: To ensure that only competent graduates are licensed to practice nursing, councils conduct licensing examinations, which may include among others clinical competency assessment. This review explored current practices in clinical competency assessment of nursing students as part of a larger study aimed at developing an evidence-based, context-specific framework for clinical competency assessment in a sub-Saharan African (SSA) country.Methods: A scoping guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted.Results: Findings from 28 out of 1151 studies identified from Scopus, PubMed, CINAHL, Wiley Online Library, and ProQuest were included and synthesized. Results show that a good assessment system must be valid, reliable, transparent, feasible, fair, objective,and must provide feedback and continually improve to have an educational impact. Clinical competency assessment systems must be developed on sound empirical evidence, pilot tested, and involve thorough training and evaluation of the examiners. Continuous evaluation of the assessment system is also essential to ensure the quality and relevance of the assessment system. Only one of the included studies was conducted in Africa.Conclusions: The paucity of clinical competency assessment research in sub-Saharan Africa may lead to benchmarking assessment systems on research conducted outside the context. Sub-Saharan Africa has a set of circumstances that demand a context-specific clinical competency assessment framework to guide clinical competency assessment.     

Impact of oral health management on mental health and psychological disease: a scoping review

ObjectiveThe relationship between oral and mental health has been controversial. Few studies have assessed the direct effects of oral health management on mental health and psychological disease. Using evidence from the last 5 years, this scoping review aimed to map and discuss recent progress in understanding this relationship.MethodsElectronic literature searches were performed using PubMed, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature databases. An additional manual search was performed using Google Scholar databases. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram.ResultsAn eligibility review process identified three randomized controlled trials for inclusion in this review. The oral health interventions and participants’ target age, mental health status, and psychological diseases varied across these studies. The only study that reported an improvement included psychosocial support integrated with educational components of oral health as the intervention. The remaining two studies detected no significant impact of oral health interventions on mental health and psychological disease.ConclusionsEvidence of the impact of oral health management on mental health and psychological disease is insufficient in studies published between 2017 and 2021.     

A narrative inquiry: moving on from homelessness for individuals with a major mental illness

This narrative study explores the experience of 'moving on' from homelessness for individuals with major mental illnesses, after they have obtained permanent housing with supports. Twelve participants were interviewed up to three times over 6 months. There were various routes to homelessness, participants were homeless for varying lengths of time, and they described different journeys of 'moving on' in their lives. Place, and a series of places, were central for participants in this experience. The experience of homelessness for many could be described as 'on the move', in a circular pattern from shelter to shelter or street. Permanent housing and supports allowed participants to 'move on', reconnecting with family, getting jobs and planning for the future. Several participants wanted their stories used to send messages of hope, courage and survival. This study highlights the need for nurses to be aware of the concept of 'place' in the process of recovery from mental illness.     

Non-psychiatric hospitalization of people with mental illness: systematic review

Title.  Non-psychiatric hospitalization of people with mental illness: systematicreview.
Aim.  This paper is a report of a literature review of the evidence regarding outcomes experienced by severely mentally ill individuals hospitalized in general medical-surgical settings for non-psychiatric conditions.
Background.  Severely mentally ill individuals experience chronic medical illnesses at a rate greater than the general population. When hospitalized in non-psychiatric settings, they tend to be experienced as 'difficult' by nurses and to have longer lengths of stay.
Data sources.  The CINAHL and PUBMED databases were searched from 1 to 9 March 2008 to identify studies published between 1998 and 2008 investigating outcomes among people with mental illness hospitalized for non-psychiatric illness in general hospitals.
Methods.  Included studies were those published in English in peer reviewed journals and investigating patient outcomes. The studies were reviewed for relevance and inclusion criteria; the methodological quality of studies was not evaluated.
Results.  Twelve studies met inclusion criteria. All studies examining length of stay, costs of care or resource utilization showed increased measures for patients with psychiatric comorbidity. Interventions described included psychiatric liaison psychiatry and nursing, which failed to demonstrate improvement in outcomes.
Conclusion.  Nurses play a pivotal role in improving the inpatient care of this vulnerable population, but they struggle in their attempts to do so. Research to determine the best approaches to promote nurses' knowledge, positive attitudes and self-confidence in caring for patients with psychiatric comorbidity is needed. Investigation of the patient perspective on the inpatient experience might also provide insight for designing effective care processes.     

Reflective practice in speech-language pathology: A scoping review

Abstract

Purpose: Within the profession of speech-language pathology, there is limited information related to both conceptual and empirical perspectives of reflective practice. This review considers the key concepts and approaches to reflection and reflective practice that have been published in the speech-language pathology literature in order to identify potential research gaps.

Method: A scoping review was conducted using Arksey and O’Malley's (2005) Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32.[Taylor & Francis Online] , [Google Scholar] framework.

Result: A total of 42 relevant publications were selected for review. The resulting literature mapping revealed that scholarship on reflection and reflective practice in speech-language pathology is limited. Our conceptual mapping pointed to the use of both multiple and generic terms and a lack of conceptual clarity about reflection and reflective practice in speech-language pathology. Two predominant approaches to reflection and reflective practice were identified: written reflection and reflective discussion. Both educational and clinical practice contexts were associated with reflection and reflective practice. Publications reviewed were primarily concerned with reflection and reflective practice by novices and expert practitioners.

Conclusion: Based on this review, we posit that there is considerable need for conceptual and empirical work with a goal to support university- and work-based educational initiatives involving reflection and reflective practice in speech-language pathology.     

Self‐expressed strengths and resources of children of parents with a mental illness: A systematic review

The aim of the present study was to explore the strengths children reported to have acquired while coping with their parents illness, and the external factors these children indicated had facilitated their coping process. A systematic literature search was conducted of peer‐reviewed papers that focused on self‐reported experiences of children with parents who had mental illness, and revealed their strengths and resources. The search included the following databases: MEDLINE, PsycINFO, and CINAHL. Results were filtered according to whether search terms appeared in the title or abstract. Fifty‐seven full‐text papers were reviewed; 26 of them met the inclusion criteria and were included in the review. The statements were analysed using content analysis. The search identified 160 relevant statements, 38 (24%) of which could be described as self‐reported strengths, and 122 (76%) as self‐reported resources. According to these statements, the children described themselves as more mature, independent, and empathic than their peers who did not have a parent with a mental illness, and as having acquired several abilities. The statements about resources indicated that the children regarded social support, information, and particularly the support of mental health‐care professionals as helpful when living with a parent with a mental illness. Recommendations for nursing actions to support children's ability to cope with their parents' illness are outlined.     

Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review

The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence‐based, best‐practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person‐centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED.     

Clients and facilitators' experiences of participating in a Hong Kong self-help group for people recovering from mental illness

The purpose of this study was to examine the effectiveness of self-help groups in the rehabilitation of people recovering from mental illness. A qualitative approach was adopted, with individual interviews of 12 clients and four focus group interviews of 22 professionals and volunteers, in a Hong Kong self-help organization. Three major categories emerged from the client interviews: the meaning of self-help; experience of self-help group involvement; and changes in life. The major categories which emerged from the focus groups were: the meaning of self-help; therapeutic factors; therapeutic process; facilitators' expectation; and difficulties encountered. Results indicated that self-help group involvement provided positive experiences for the members and led to some changes in their lives which contribute to the rehabilitation of their illness. Meanwhile, the professionals' and volunteers' view of the use of self-help groups was found to coincide with previous literature. Moreover, a spiritual dimension was expressed by all respondents as one of the factors that enhanced the group cohesiveness. It was concluded that self-help group involvement is beneficial to psychiatric rehabilitation. Findings have implications for further utilization of self-help groups for the people recovering from mental illness, as an alternative form of health care to complement the inadequacies in the present health care system.