Multidisciplinary Approach to Optimizing Pharmacological and Behavioral Interventions for Persons with Developmental Disabilities Who are on Psychotropic Medications

Psychiatric, pharmacological, and behavioral assessments and interventions were provided to consumers with developmental disabilities who were on psychotropic medications. In addition, training programs on the steps in psychiatric assessment, implementation of behavioral interventions, and administration of medication procedures were conducted for service providers working with this population. Following assessments and interventions, 20 of 40 participating consumers (50%) received fewer psychotropic medications while their challenging behaviors could be effectively managed. Service providers receiving training scored significantly higher on post tests than on pre tests on psychiatric assessment steps, medication management procedures, and positive behavior interventions. A high level of satisfaction with the training process was reported by the majority of these participating service providers. The practical implications of the findings of this project were discussed.     

Intermediate care: An interprofessional education opportunity in primary care

Background

Primary Care Trust Intermediate Care Services provides a range of services from occupational therapists, physiotherapists, nurses and social workers to clients in a community setting. With pre-registration students from two universities participating in placements at the Primary Care Trust, an opportunity for the students to observe professionals working together and to take part in interprofessional education (IPE) sessions was identified. A pilot project was undertaken to study how IPE may be made an explicit objective of learning that was already occurring in practice, particularly in light of the document “Creating an interprofessional workforce: An education and training framework for health and social care in England” (), which aims to provide the guidance needed to “mainstream IPE across health and social care”.     

Bridging the discharge process: staff and client experiences over time

Before the “Bridge to Discharge” innovation, hospital and community services were largely separate, and the consumer group was rarely included in direct clinical issues. The “Bridge to Discharge” project involves a partnership among a psychiatric hospital schizophrenia program, a public health program, and a consumer group to assist individuals who had experienced lengthy psychiatric admissions reintegrate into the community. This article reports the qualitative evaluation of client and staff responses every other month regarding the changes in this project. Clients described “hope” for a life outside the hospital and the importance of working with staff they knew. Role changes for both the inpatient nurses and the public health nurse reflect role expansions and a broader attention to client issues. Partnerships among hospital, community, and consumer groups have the potential to assist clients to make the transition to successful community living. Understanding the changes over time resulting from innovations will assist nurses and others in planning for appropriate services and supports.     

A Turning Point Towards Recovery: An Interview Study with Participants in the Culture and Health Programme for Clients with Long-Term Mental Health Disorders in Sweden

The study aimed to explore participants’ perceptions and experiences of the Culture and Health programme in Sweden for clients with long-term mental health disorders. A qualitative approach with interviews was applied. Grounded Theory guided the analysis and selection of informants. A total of 15 informants were interviewed. A core category ‘A turning point in dealing with everyday life beyond the mental illness’ with three categories: inner life, social life and occupational life emerged. A theory indicating the importance of asking clients about their expectations, was formulated. Further studies are warranted, including studies of effects.     

Care control and collaborative working in a prison hospital

This paper reports findings from a qualitative research project, using interviews, focus groups and participant observations, which sought to investigate “good practice” in a nurse-led prison hospital wing for male prisoners. The study raised issues about tensions between “caring” and “control” of prisoners from the perspectives of professionals working or visiting the wing. This paper discusses collaborative working between professionals from different backgrounds, including nurses and healthcare (prison) officers who were based on the wing and others who visited such as probation, medical, Inreach team or Counselling Advice, Referral, Assessment and Through Care team staff (CARAT). The key finding was that there is a balance between therapy and security/risk. In order to maintain this, the two main groups based on the hospital wing – nurses and prison officers – moved between at times cooperating, coordinating and collaborating with each other to maintain this balance. Other themes were care and control, team working, individual and professional responsibilities and communication issues. Enhancing the role of nurses should be encouraged so that therapy remains paramount, and we conclude with some recommendations to encourage collaborative working in prison healthcare settings to ensure that therapy continues to be paramount while security and safety are maintained.     

The Views of Clients with Mild Intellectual Disabilities Regarding their Working Relationships with Caregivers

Background Research studies into the effect of therapies have shown that a good relationship between the client and his caregiver is a key factor in a positive treatment outcome. Methods The nominal group technique (NGT) has been used in this study to discover what clients with intellectual disabilities feel contributes to a successful working relationship with caregivers. Results The research reveals that from the clients’ perspective the way in which caregivers deliver their support (a reliable, empathic and non‐patronising attitude) is important. The particular types of support seem to be less influential in terms of treatment success. Furthermore, the results show that the clients’ preferred ways of receiving help correspond with the basic assumptions in solution focused brief therapy. Conclusions This research project demonstrates that the NGT is a valuable instrument in bringing to the fore of the opinions and priorities of clients with intellectual disabilities. Comparisons with studies into the client‐professional working relationships among children and adults without intellectual disabilities reveal similarities to the outcomes of this research project.     

Benefits and barriers to physical activity for individuals with disabilities: a social-relational model of disability perspective

Abstract

Purpose: To provide a qualitative overview of selected research on physical activity (PA) engagement by people with physical disabilities from a social relational model perspective. Method: Selected articles that exemplify some of the paradoxes, nuances, contrasting perspectives and complexities of the knowledge base in this area are discussed within a disability studies framework. Results: PA is arguably more important for people with disabilities relative to people without disabilities although they are quite inactive. Individuals who are physically activity enjoy a range of benefits spanning physiological, emotional, cognitive and social categories. Unfortunately many people cannot enjoy the benefits of PA because of the many medical, psychological, social and environmental barriers they face making PA quite difficult. Conclusions: Rehabilitation professionals can provide a better standard of care to clients if they are aware of the benefits and barriers of PA.

• Implications for Rehabilitation

• Rehabilitation professionals should understand behavior change strategies and their application to people with disabilities in order to help their clients initiate and maintain physical activity (PA).

• Rehabilitation professionals should be aware of how they might convey low PA expectations to their clients and simultaneously understand the unique challenges faced by their clients in attempting to incorporate PA into their lives on a regular basis.

• Rehabilitation professionals should be familiar with local disability friendly exercise facilities and adapted sport programs in order to steer their clients towards such opportunities.

     

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: the importance of belonging,fun, and control and choice

Abstract

Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities – those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a “following a thread” technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths’ experiences.

• Implications for Rehabilitation

• Service providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on “participating” in an “activity” to build specific skills.

• In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun.

• It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences.

• It is important not to “over-therapize” youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities.

     

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson’s Disease,Students and Clinical Educators

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson’s Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: “client-centredness”; “who am I/why am I here?”; “understanding interprofessional collaboration and development”; “personal and professional development, awareness of self and others”; “the environment - safety and support”. These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of “navigating interprofessional spaces” showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.     

Relatedness theory as a framework for the treatment of fatigued women

Fatigue is a phenomenon that advanced practice psychiatric nurses may see in both psychiatric and nonpsychiatric clients. Qualitative study findings support the need for health care professionals to intervene with the relational effects of fatigue. This article details the use of relatedness theory as a framework for nursing interventions. Relatedness states of disconnectedness and parallelism, and changes in relatedness elements of synchrony, sense of belonging, reciprocity, and mutuality are addressed. Therapeutic approaches to the negative relatedness influences of fatigue include evaluating the lack of presence, decreasing expectations, addressing effects on the family, and influencing the states and elements of relatedness.     

Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review

This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web‐based repositories was conducted. The searches were conducted using a combination of key terms: “mental health professionals”, “students”, ‘knowledge’, “understanding”, “perception” “attitude”, “expectation”, “recovery”. After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed‐method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed‐method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in‐service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).     

The patient's daily activities in acute psychiatric care

The patient's daily activities in acute psychiatric care
This study is part of a research project entitled:'Towards patient-focused nursing on an acute psychiatric ward'. The aim of the project is to describe the changes taking place in nursing activities during a research project. This paper is a qualitative analysis of the patient's daily activities in acute psychiatric care. The data were collected by observing, selectively, seven patients for 61 h. The constant comparative method was used in data analysis. On the basis of the data analysis, the categories listed below were identified.
1 The core category of the patient's daily activities was'being a patient'.
2 Being a patient mainly consisted of being alone without meaningful activities.
3 Participating in the daily routines of the ward consisted of being alone while being together with others.
4 Being together was initiated by either the patient or the nurse. The aim of being together was to satisfy the acute basic needs of the patients.
5 Being together on the initiative of the nurse meant participating in the daily routines of the ward.
Because the data were collected by observation, no insight into the patients'desires, expectations and thoughts could be presented. The findings challenged the nursing staff to develop a more therapeutic daily routine in acute psychiatric care. It was also of importance to change the patients'meaningless existence into a meaningful participation in the daily activities on the ward.     

The expertise of Finnish occupational health nurses

This study describes the self-assessed activities, features, prerequisites, and consequences of occupational health nurses' expertise. The quantitative data were gathered from 468 Finnish occupational health nurses, of whom 373 (80%) returned the completed questionnaire. The data were analyzed by using one-way-anova, the Kruskal-Wallis or the chi(2)-tests. The activities of the occupational health nurses included working with employees, workplaces, and collaborative partners, administrative and office work, and other duties. The most important expert features were the holistic perspective and listening to clients. Continuing training and a positive attitude were the most necessary prerequisites for expertise. The main benefits of expertise, from the perspective of the occupational health nurses, were improved health and a decreased number of work-related health risks. Support by the work community and good educational possibilities were important for expert practice. Occupational health nurses need to develop their expertise continually because they play a key role in promoting workers' health.     

Health professionals in multi-disciplinary and multi-agency teams: Changing professional practice

The article draws on an Economic and Social Research Council (ESRC)-funded research project that aimed to investigate the reality behind the rhetoric of “joined up thinking”. The research project was a qualitative, multi-method study involving three phases, including observation and documentary analysis; interviews; and focus groups around decision making and knowledge sharing. The article reflects on the perspectives and experiences of health professionals and their colleagues in multi-agency teams about the impact of multi-agency teamwork on their professional knowledge and learning, and on their ways of working. Actual and potential conflicts between professionals are explored about models of understanding, about roles, identities, status and power, about information sharing, and around links with other agencies. Dilemmas of team building and of conflicting values and knowledge are exemplified from health professionals' accounts, using theoretical models of “communities of practice” and “activity theory”. The article presents groups of strategies that health professionals and their colleagues in multi-agency, multi-professional teams use to overcome barriers and to strengthen team cohesion. The conclusion reflects on some implications of our findings in theory and practice for professionalism within integrated, multi-professional teams that are building new ways of working.     

Interventions in forensic psychiatry: the caregiver's perspective

Although a number of official reports have identified the needs of the caregivers of mentally disordered offenders (forensic clients), there has been limited research in this area. However, some consistent themes have started to emerge from the literature. The burdens being faced by healthcare professionals working with forensic clients are distinct from that of those working with non-forensic clients, with levels of violence directed towards the former being much higher. Levels of professional and social contact are also much reduced for healthcare professionals working in forensic psychiatry. New research seems to show that illness representations (beliefs) have an effect on the coping responses employed by the caregivers of forensic clients. This may be an area that caregivers can focus on in the future to both develop interventions and improve levels of contact and satisfaction with healthcare professionals.     

Healthcare professionals’ perceptions of the value and impact of the arts in healthcare settings: A critical review of the literature

BackgroundInternationally there is growing interest in the use of the arts in the healthcare context evidenced by the number of research studies reported in the nursing and medical literature. Establishing successful projects in healthcare environments will to some extent be reliant on the cooperation of staff working in these settings: healthcare professionals and their cultural values will be the lynchpin in the relationship between the artists organising the activities and the patients. This review appraises healthcare professionals’ perceptions of the value of the arts in healthcare settings, and the impact of the arts on healthcare professionals.MethodsA critical review of the literature between 2004 and 2014 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: arts activities; healthcare settings, and healthcare providers. Studies were included if they were written in English, explored the attitudes of healthcare professionals on the use of the arts in healthcare settings or the impact of arts activities on healthcare staff. Studies conducted in community venues and/or reporting on arts therapies (art, drama or music) were excluded. An initial 52 studies were identified and following screening for relevance and quality 27 articles were reviewed. Arts interventions were diverse and included music listening, visual arts, reading and creative writing, and dance.ResultsDespite some methodological limitations of the reviewed studies it was found that the majority of staff believed that engaging in arts interventions has a positive impact on patients’ health and well-being. The findings suggest that arts interventions are perceived to have an impact on patients’ stress, mood, pain levels, and sleep. Furthermore, staff believed that the arts can enhance communication between staff and patients, helping to build rapport and strengthen interactions. The majority of reported staff outcomes were positive, with arts activities in healthcare settings found to: decrease stress, improve mood, improve job performance, reduce burnout, improve patient/staff relationships, improve the working environment and improve well-being.ConclusionsThis review fills a gap in the literature, providing the first review of healthcare professional's views of the arts in healthcare settings and the impact of arts activities on healthcare staff. The largely positive perceptions of staff will aid in the implementation of arts activities in healthcare settings, which will enhance care and benefit both patients and healthcare staff.     

Technology for improving cognitive function. A workshop sponsored by the U.S. Interagency Committee on Disability Research (ICDR): Reports from working groups

The U.S. federal Interagency Committee on Disability Research (ICDR) and its Subcommittee on Technology (IST) sponsored a state of the art workshop on “Technology for Improving Cognitive Function”, from 29 – 30 June 2006 in Washington, D.C. This paper summarizes the content of the working groups charged with providing strategic direction for the future of technology for persons with cognitive disabilities.     

Clients with mental health problems who sexualize the nurse-client encounter: the nursing discourse

Title. Clients with mental health problems who sexualize the nurse‐client encounter: the nursing discourse. Aim. This paper is a report of a study of psychiatric nurses’ responses to clients who were sexualizing the nurse–client encounter. Background. Studies involving general nurses have reported incidents of ‘unwanted sexual attention/behaviour’ from clients. These behaviours have been identified, in the literature, as a form of sexual aggression and sexual harassment. Reported responses have included physically avoiding the person, ignoring verbal comments or adopting a no‐‘nonsense’ professional approach. Methods. A grounded theory study was conducted in 2005–2006 using tape‐recorded unstructured interviews with 27 psychiatric nurses working in an urban mental health service in the Republic of Ireland. Tapes were analyzed, with the assistance of Nud*ist 4, Word documents, mind maps and memoing. Findings. There were unwritten and unspoken professional expectations or norms that clients treated participants and nursing encounters in an asexual way. However, on occasions, clients transgressed these taken‐for‐granted norms and engaged in behaviour labelled ‘sexualizing the nurse–client encounter’. In contrast to previous studies, our interviewees did not use the language of sexual harassment, but used the discourses of ‘mad/bad’ and ‘inappropriate’ to codify the behaviour. The tendency to view behaviour through the psychiatric discourse of badness and boundary violation gave rise to nurses either ignoring the behaviour or responding by using ‘suppressive strategies’. Consequently, other possible lenses of understanding were pushed to the background. Conclusion. Only when educators and clinicians view clients’ sexual behaviours through alternative lenses of understanding will different actions and outcomes become possible and the rights of all, both nurses and clients, be respected.