Cognitive behaviour therapy within acute mental health care: a critical appraisal

This paper examines the evidence for the use of cognitive behavioural therapy (CBT) within acute mental health-care settings. Through the provision of a literature review the authors critique the research into the effectiveness of CBT when delivered within acute mental health-care settings, to clients who are acutely psychotic. The review concludes with recommendations for future research to expand the current evidence base.     

An exploration of mental health nursing models of care in a Queensland psychiatric hospital

This qualitative study that took place in 2006 in a publicly funded Queensland psychiatric hospital explored nursing models of care from multiple points of view. Eleven participants were interviewed. Two were post-acute consumers, three were nurse unit managers, one was an enrolled nurse, and the remaining five were registered nurses. Even though participants valued an approach that was different to a medical model, in the absence of an explicit nursing approach, the predominantly illness-care culture led nurses to resort to problem-focused care. Relying on implicit models of care created inconsistencies and precluded the nursing strategies from being systematically evaluated, revised, or extended. Various changes were identified and included the desire for further consultation and staff development so that an explicit model of care could be introduced and evaluated.     

How to learn skilled communication in primary care MUS consultations: a focus group study

BackgroundMany general practitioners (GPs) experience communication problems in medically unexplained symptoms (MUS) consultations as they are insufficiently equipped with adequate communication skills or do not apply these in MUS consultations.ObjectiveTo define the most important learnable communication elements during MUS consultations according to MUS patients, GPs, MUS experts and teachers and to explore how these elements should be taught to GPs and GP trainees.MethodsFive focus groups were conducted with homogeneous groups of MUS patients, GPs, MUS experts and teachers. MUS patients and GPs formulated a list of important communication elements. MUS experts identified from this list the most important communication elements. Teachers explored how these elements could be trained to GPs and GP trainees. Two researchers independently analysed the data applying the principles of constant comparative analysis.ResultsMUS patients and GPs identified a list of important communication elements. From this list, MUS experts selected five important communication elements: (1) thorough somatic and psychosocial exploration, (2) communication with empathy, (3) creating a shared understanding of the problem, (4) providing a tangible explanation and (5) taking control. Teachers described three teaching methods for these communication elements: (1) awareness and reflection of GPs about their feelings towards MUS patients, (2) assessment of GPs’ individual needs and (3) training and supervision in daily practice.ConclusionTeachers consider a focus on personal attitudes and needs, which should be guided by opportunities to practice and receive supervision, as the best method to teach GPs about communication in MUS consultations.

KEY POINTS

• Many GPs experience difficulties in communication with patients with MUS.
• There is a need to equip GPs with communication skills to manage MUS consultations more adequately.
• Role-playing with simulation patients, reflection on video-consultations and joint consultations with the supervisor may increase the GPs’ awareness of their attitude towards MUS patients and may help GPs to identify their individual learning-points.

     

Areas of nursing competence in acute wound care: A focus group study

BackgroundWound care is an essential part of registered nurses’ work. However, previous studies have indicated that registered nurses have limited competence in this area. Studies have also highlighted the lack of consistent and standardised areas of competence for registered nurses providing wound care.AimTo identify general areas of competence for registered nurses providing acute wound care during their transition from student to healthcare professional.MethodsFocus group interviews were used to collect the data (N = 20). Separate focus groups were held for participants representing the following professions: (i) registered nurses; (ii) authorised wound care nurses; (iii) nurse educators; and (iv) physicians. The data were analysed using two-step inductive-deductive content analysis.FindingsThe two main competence areas for registered nurses who provide care for patients with acute wounds were: (i) knowledge, skills, and performance in aetiology and care; and (ii) wound management and assessment. These competence areas were divided into more detailed subcategories. The desired values and attitudes were as follows: respect for autonomy and privacy; holistic care; professionalism and courage; and economics related to wound care.DiscussionRegistered nurses play an essential role in the care and prevention of wounds. Nursing education on acute wound care could focus on the identified competence areas to cover the core competences for providing evidence-based, best-quality care for patients with acute wounds.ConclusionsWith consistent and structured competence areas, it would be possible to develop and improve wound care education and training at the undergraduate and postgraduate level.     

Social support within a mother and child group: An ethnographic study situated in the UK

Social support has been associated with positive outcomes regarding the mothering experience, and professional interventions have therefore been developed in formal settings to promote this. An ethnographic approach was used to consider the subjective experiences of mothers attending a professionally‐facilitated group for parents and children aged 0–4 years, focusing on relationships within the group and their importance within existing social networks. Qualitative data were collected from seven participants using interviews and participant observation. These were analyzed by the constant comparison method into codes, categories, and themes. Three themes emerged: past history, being a mother, and function of the group. To ensure mothers and children benefit from such groups, nurses who participate in developing and leading community interventions for mothers and their children need to be aware of the importance of maternal identity and the factors that can impact the relationships between mothers within group settings.     

Developing a scale of communicative participation: a cognitive interviewing study

Purpose. To revise and improve the instructions, candidate items and response format for a tool to measure communicative participation.

Method. Cognitive interviewing techniques, designed to study the process that respondents use to answer survey questions, were used to test a bank of candidate items for a measure of communicative participation. Twelve participants with spasmodic dysphonia (SD), a neurologic condition characterized by voice and speech changes, were asked to complete a sample questionnaire and then were interviewed regarding the clarity of instructions, candidate items and response format. Analysis of the interviews was conducted using qualitative techniques and resulted in a series of modifications to the measurement tool.

Results. Problems identified related to candidate items included inadequate context, double-barreled or ambiguous items, redundancy, unclear or generally confusing items, infrequent situations, and cultural sensitivity. Participants preferred response options that asked them to rate interference rather than other dimensions such as satisfaction.

Conclusions. Subtle differences in items and response options make key differences in how participants interpret and make decisions about their responses. Rich contextual information is needed in order to respond to items that sample communicative participation. Participants preferred response options that capture the barriers that they experience when participating in everyday communication situations.     

Developing a scale of communicative participation: A cognitive interviewing study

Purpose. To revise and improve the instructions, candidate items and response format for a tool to measure communicative participation.

Method. Cognitive interviewing techniques, designed to study the process that respondents use to answer survey questions, were used to test a bank of candidate items for a measure of communicative participation. Twelve participants with spasmodic dysphonia (SD), a neurologic condition characterized by voice and speech changes, were asked to complete a sample questionnaire and then were interviewed regarding the clarity of instructions, candidate items and response format. Analysis of the interviews was conducted using qualitative techniques and resulted in a series of modifications to the measurement tool.

Results. Problems identified related to candidate items included inadequate context, double-barreled or ambiguous items, redundancy, unclear or generally confusing items, infrequent situations, and cultural sensitivity. Participants preferred response options that asked them to rate interference rather than other dimensions such as satisfaction.

Conclusions. Subtle differences in items and response options make key differences in how participants interpret and make decisions about their responses. Rich contextual information is needed in order to respond to items that sample communicative participation. Participants preferred response options that capture the barriers that they experience when participating in everyday communication situations.     

Operating theatre nurses' perceptions of competence: a focus group study

Title.  Operating theatre nurses' perceptions of competence: a focus group study.
Aim.  This paper is a report of a study exploring nurses' perceptions of the components of competence in the operating theatre.
Background.  Competency Standards for operating theatre practice are used in some countries to guide clinical and professional behaviours. The need for competence assessment has been enshrined, but the conceptualization and agreement about what signifies competence in Operating Theatre has been lacking.
Methods.  Three focus groups were conducted with 27 operating theatre nurses in three major metropolitan hospitals in Queensland, Australia. Interviews were audio taped and field notes were taken. Data were collected during 2008. Thematic analysis was performed.
Findings.  From the analysis of the textual data, three themes were identified: 'coalescence of theoretical, practical, situational and aesthetic knowledge within a technocratic environment'; 'the importance of highly developed communication skills among teams of divergent personalities and situations'; and 'managing and coordinating the flow of the list'.
Conclusion.  These findings have identified that competence in respect to components of knowledge, teamwork and communication, and the ability to coordinate and manage are important and should be incorporated in operating theatre Competency Standards. Additionally, findings may assist in the development of an instrument to measure operating nurses' perceived competence.     

Family group conferences in public mental health care: an exploration of opportunities

Family group conferences are usually organized in youth care settings, especially in cases of (sexual) abuse of children and domestic violence. Studies on the application of family group conferences in mental health practices are scarce, let alone in a setting even more specific, such as public mental health care. The present study reports on an exploratory study on the applicability of family group conferencing in public mental health care. Findings suggest that there are six reasons to start family group conference pilots in public mental health care. First, care providers who work in public mental health care often need to deal with clients who are not motivated in seeking help. Family group conferences could yield support or provide a plan, even without the presence of the client. Second, conferences might complement the repertoire of treatment options between voluntary help and coercive treatment. Third, clients in public mental health care often have a limited network. Conferences promote involvement, as they expand and restore relationships, and generate support. Fourth, conferences could succeed both in a crisis and in other non-critical situations. Sometimes pressure is needed for clients to accept help from their network (such as in the case of an imminent eviction), while in other situations, it is required that clients are stabilized before a conference can be organized (such as in the case of a psychotic episode). Fifth, clients who have negative experiences with care agencies and their representatives might be inclined to accept a conference because these agencies act in another (modest) role. Finally, the social network could elevate the work of professionals.     

Nurses' perceptions of discharge planning in acute health care: a case study in one British teaching hospital

AIM OF THE STUDY: To provide an in-depth understanding of nurses' perceptions of the hospital discharge process in a London teaching hospital. BACKGROUND: Discharging patients from hospital is a key component of the nurse's role in acute health care settings. It is remarkable that despite government legislation and research, which stretches back over 20 years in both Europe and North America, discharge planning remains problematic. Furthermore, it is an activity that requires collaboration between health and social care agencies. In the United Kingdom there is a new emphasis and incentive on managing acute hospital beds, which in turn results in shorter stays in hospital. In London, discharge planners face additional problems because of social, economic and environmental factors. METHOD: Using a case study design, 19 nurses were interviewed using the critical incident approach to obtain their perceptions of the discharge process. Direct observation was conducted to record interactions between nurses and health care professionals in multidisciplinary teams. In total 14 meetings were attended in elder care and orthopaedics and 7 in acute medicine. FINDINGS: Aspects of the discharge process were often ignored or neglected and assessments were rarely co-ordinated. The nursing ward handover was regarded as a process that hindered communication. Lack of time was reported to be the biggest barrier that affected interprofessional working and hence the co-ordination of assessments. CONCLUSION: The findings have important implications for nurses, managers and educational establishments. It is essential that social and medical diagnoses run parallel and that accurate information is collated and communicated within the multidisciplinary team. Further research into the impact of time pressures on communication, interprofessional working and the discharge process is needed.     

Transdisciplinary approach: an atypical strategy for improving outcomes in rehabilitative and long-term acute care settings.

In the rehabilitation and long-term acute care settings, an atypical strategy has emerged in the past few years whereby the central focus is on improving patient care through a team approach in which responsibilities are shared and the normal boundaries of the healthcare professions blurred. This article provides a conceptual analysis of this unique, transdisciplinary approach to care delivery. Differentiation between interdisciplinary, multidisciplinary, and transdisciplinary techniques is provided through case scenarios. Defining attributes, necessary antecedents, and the many possible positive outcomes from the transdisciplinary approach to practice is discussed. This concept analysis defines for the rehabilitation or long-term acute care nurse a method that can be used to redesign care delivery, to promote improved patient outcomes, and to achieve a cohesive team environment.     

Family and carer participation in mental health care: perspectives of consumers and carers in hospital and home care settings

It is widely accepted that family and carer participation in adult mental health care is desirable. However, rarely is service development informed by representative opinions of both carers and service users. This study took place in the context of a larger project to introduce and evaluate practice standards relating to family participation. The aim of this paper is to explore the perceptions of service users and carers to carer participation in adult mental health services. One hundred and twenty-nine service users and 86 family members recruited via hospital and community settings completed a survey which addressed obstacles to family participation, perceived benefits of participation and areas for improvement. Many service users and family were entirely satisfied with existing levels of family participation. Different needs for information, support and the nature of participation in mental health care are highlighted in acute hospital and community settings. Across settings, the provision of support and accessing services were identified as the most useful aspects of family participation. Meaningful carer and family participation in mental health care should proceed from respectful connection with carers and be informed by need which will vary depending on setting and circumstances.