Perceived barriers to providing spiritual care among psychiatric mental health nurses

BackgroundAlthough nurses typically view spiritual care as important, it is provided infrequently.ObjectivesThis research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.MethodsThis cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.ResultsThe most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.ConclusionsNurses need education about providing spiritual care to those with psychiatric mental health needs.     

Role of fear of movement in cancer survivors participating in a rehabilitation program: a longitudinal cohort study

Velthuis MJ, Peeters PH, Gijsen BC, van den Berg JP, Koppejan-Rensenbrink RA, Vlaeyen JW, May AM. Role of fear of movement in cancer survivors participating in a rehabilitation program: a longitudinal cohort study.ObjectiveTo study the relationship between fear of movement and perceived global health status and the role of rehabilitation with graded activity in cancer survivors.DesignLongitudinal cohort study.SettingRehabilitation centers.ParticipantsCancer survivors (N=1236).InterventionTwelve-week graded activity rehabilitation program.Main Outcome MeasuresFear of movement (Modified Tampa Scale for Kinesiophobia-Fatigue), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and perceived global health status (European Organisation Research and Treatment of Cancer Quality of Life Questionnaire C30) were measured at baseline and after rehabilitation. We performed multiple linear regression analyses to examine the association between fear of movement and perceived global health status at baseline. Differences between baseline and postintervention scores were assessed with a paired t test and effect sizes (ESs). Hierarchical multiple regression analyses were used to investigate whether changes in fear of movement were associated with perceived global health status.ResultsFear of movement was associated with perceived global health status prior to rehabilitation (P=.001). Only participants with high scores on baseline fear of movement showed a considerable decrease in fear of movement after rehabilitation (ES=–.69; 95% confidence interval [CI], ?.80 to ?.57); the reduction was largest for fears because of a somatic focus (ES=–.57; 95% CI, ?.68 to ?.45). Changes in fear of movement because of a somatic focus were related to perceived global health status postintervention (P=.001).ConclusionsFear of movement is associated with the perceived global health status of cancer survivors. Fear of movement decreases after rehabilitation with graded activity in high scorers on baseline fear of movement.     

Health problems of women with severe mental illness

PURPOSE: To provide a review of the health problems of women with severe mental illness (SMI) that are related to their psychiatric disorders and disabilities, prolonged use of psychotropic medications, and high-risk lifestyle practices. DATA SOURCES: Review of current literature uncovered through MEDLINE, Cumulated Index to Nursing and Allied Health, and Psychological Abstracts as well as the authors' clinical experiences. CONCLUSIONS: Women with SMI are at increased risk for obesity as well as cardiovascular, endocrine, and infectious disorders. They also experience psychotropic medication-related disorders such as amenorrhea, galactorrhea, sexual dysfunction, breast cancer, and osteoporosis. High-risk lifestyle practices, excessive weight gain, low physical activity, substance abuse and unprotected sexual activity increase risk for health problems. The mental illness, residual disabilities, sequelae of childhood abuse, poverty, limited social support and health knowledge deficits affect their ability to maintain optimum health. IMPLICATIONS FOR PRACTICE: Knowledge about women with SMI and their health problems will enable nurse practitioners to better meet the needs of this vulnerable population.     

Somatic healthcare utilization among adults with serious mental illness who are receiving community psychiatric services

BACKGROUND/OBJECTIVE: Somatic health care utilization was studied among individuals with serious mental illness who were receiving community-based psychiatric services. RESEARCH DESIGN: Cross-sectional study. SUBJECTS: A total of 200 outpatients, 100 with schizophrenia and 100 with affective disorder, were recruited from randomly selected samples receiving care at two psychiatric centers. MEASURES: Patients were interviewed using questions from national health surveys. Multiple logistic regression analyses were used to compare responses from each sample to those of matched subsets of individuals from the general population. RESULTS: The psychiatric samples were more likely to report receiving some medical care services in the past year than were individuals in the general population including having visited a general medical doctor (Odds ratio, schizophrenia sample = 2.04; Odds ratio, affective disorder sample = 2.37) and having a complete physical examination (Odds ratio, schizophrenia sample = 2.69; Odds ratio, affective disorder sample = 1.74). However, our samples were less likely to receive routine dental care (Odds ratio, schizophrenia sample = 0.46; Odds ratio, affective disorder sample = 0.60). Perceived barriers to receiving medical care were reported significantly more often by the patient groups than the comparison groups (Odds ratios > 3). CONCLUSIONS: General health services are widely utilized by individuals with serious mental illness who are in outpatient psychiatric care. Dental services remain underutilized, however, and there is a high rate of perceived barriers to receiving medical care in this population.     

Lessons Learned from Implementing a Pilot RCT of Transitional Care Model for Individuals with Serious Mental Illness

We adapted an evidence-based transitional care model for older adults being released from acute care hospitals for patients with serious mental illness and medical co-morbidities being discharged from two psychiatric units of an acute care hospital (TCare) and evaluated implementation issues. An advisory group (AG) of community stakeholders assessed barriers and facilitators of a 90-day T-Care intervention delivered by a psychiatric nurse practitioner (NP) in the context of conducting a pilot randomized controlled trial. Minutes of AG and case narratives by NP of 20 intervention participants were content analyzed. Patients with immediate and pressing physical health problems were most receptive and actively utilized the service. Provider barriers consisted of communication and privacy issues making it difficult to contact patients in mental health facilities. In contrast, the NP was accepted and valued in the physical health arena. Psychosocial needs and relationship issues were demanding, and we recommend a team approach for TCare with the addition of a social worker, peer provider, and consulting psychiatrist for severely mentally ill patients being released from an acute physical health hospitalization.     

Barriers to Seeking Early Psychiatric Treatment amongst First-episode Psychosis Patients: A Qualitative Study

Aims: The aim of this study was to explore the family members' determinant of the delay in seeking psychiatric care to patients diagnosed with psychosis. Methods: Qualitative semi-structured interviews were carried out with twenty-seven family members of patients with psychosis at psychiatric outpatient clinics in Amman, Jordan. Results: The findings revealed that perceived stigma and fears about being labelled are the main barriers to requesting early psychiatric health care. The participants cited many different reasons linked to finding help led to delay in seeking help in the early stages of the illness including misattribution of the cause and symptoms of mental illness, family and financial factors. Conclusions: The study highlights the importance of enhancing knowledge about the schizophrenia-related spectrum to ensure patients seek treatment in a more timely manner.     

Physical activity determinants in adults. Perceived benefits, barriers, and self efficacy.

The determinants of physical activity in adults were explored in this study. Explanatory variables included perceived benefits of and perceived barriers to physical activity, and perceived self efficacy for physical activity. Inactive participants were asked to identify barriers to activity, and active participants cited cues prompting them to adopt a physically active lifestyle. Data were collected from 137 adults obtained from work sites, an evening college program, and church groups. Overall, participants were physically active. Self efficacy was the only variable to predict physical activity. Race (i.e., being White) and body mass index (i.e., being overweight) explained perceived barriers to activity. The primary reason for inactivity was lack of time, and the most frequently cited cues to activity were dissatisfaction with one's weight or appearance. Few nursing studies have attempted to increase participants' levels of self efficacy. However, the occupational health nurse is in a unique position to increase workers' perceived self efficacy for activity and, in turn, their activity levels.     

Physical activity attitudes and preferences among inpatient adults with mental illness

The life expectancy of adults with mental illness is worse than that of the general population and is largely due to poor physical health status. Physical activity has been consistently recommended for the prevention and management of many chronic physical health conditions and can also have benefits for mental health. This cross sectional study assessed the attitudes towards and preferences for physical activity among inpatient adults with mental illness, and differences by distress and gender. Self‐report questionnaires were completed by 101 patients. Findings indicated that inpatient adults with mental illness are interested in doing physical activity while in hospital, primarily to maintain good physical health and improve emotional wellbeing. Fewer than half of participants agreed that physical activity has benefits for serious mental illness. Participants indicated a preference for walking and physical activity that can be done alone, at a fixed time and with a set routine and format. Major barriers were fatigue and lack of motivation. Females were more likely than males to prefer activities done with others of the same gender (P = 0.001) and at the same level of ability (P < 0.001). There were no significant differences by level of distress. These findings can inform physical activity intervention programming in hospital settings, which may contribute to decreasing the chronic disease burden and improve the psychological wellbeing in adults with mental illness.     

Attitude Disentangled: A Cross-Sectional Study into the Factors Underlying Attitudes of Nurses in Dutch Rehabilitation Centers toward Patients with Comorbid Mental Illness

In rehabilitation centers, many patients suffer a comorbid mental illness. Nurses have different attitudes toward these patients. A cross-sectional, questionnaire-based study among nurses in Dutch rehabilitation centers was undertaken to clarify the factors that underlie attitudes toward patients with comorbid mental illness. The main factors associated with attitudes were feelings of competence and experiences with dealing with patients with mental illness. Other associations were perceived support; frequency of caring for patients with comorbid mental illness; work experience in mental health care; additional psychiatric training; and the personality traits “extraversion,” “emotional stability,” and “openness to experience.” Perceived support had the strongest association with feelings of competence.     

Nursing considerations in psychotropic medication-induced weight gain

PURPOSE/OBJECTIVES: The purpose of this clinical project is to emphasize the importance of prevention/treatment of psychotropic medication-induced weight gain. Professionals who work with patients taking psychotropic medications should provide a weight management program specifically designed to address the unique needs of the mentally ill patient. BACKGROUND/RATIONALE: Psychotropic medications used in the treatment of serious psychiatric disorders are associated with body weight gain. Medication-induced weight gain can lead to serious health issues and noncompliance with needed treatment. DESCRIPTION OF THE PROJECT: Current literature and discussion of possible mechanisms of pharmacologically induced weight gain are reviewed. Health issues related to weight gain are summarized. The nursing process is then used to assess, diagnose, plan, implement, and evaluate a program of weight management for pharmacologically treated psychiatric patients. OUTCOMES: Research findings demonstrate an increased rate of obesity in pharmacologically treated psychiatric patients. This phenomenon is probably multifactorial and leads to physical complications, psychological consequences, and noncompliance with treatment. Patients with mental health disorders can effectively control their weight if they are supported by a weight management program specifically designed to meet their needs. INTERPRETATION/CONCLUSIONS: Early intervention can prevent or minimize weight gain. Weight gain when it does occur can be reversed through a program of weight management. Nurses can utilize the nursing process to develop a weight management program that provides for the special needs of mentally ill clients. IMPLICATIONS FOR NURSING PRACTICE: Psychotropic medication-induced weight gain is an often neglected problem that is not readily addressed in the clinical setting. On the basis of the scope of the problem, nurses should view medication-induced weight gain as a priority. Nurses are in a unique position to design and implement an individualized weight management program through the collaborative and holistic strategies that the nursing process provides.     

Optimal management of mental health patients in Australian emergency departments: Barriers and solutions

Objectives: The study aimed to describe: (i) the perceived barriers faced by emergency clinicians in the assessment and management of patients presenting with a mental health complaint to Australian hospital EDs; and (ii) perceived strategies to optimize care of the mentally unwell in the ED. Methods: Semistructured interviews with open and closed question formats were used to explore the barriers perceived by ED doctors and nurses in assessing and managing patients with mental health presentations. Interviews were transcribed verbatim and thematically coded by two researchers using the Framework Approach. Results: Thirty‐six interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College of Emergency Nursing Australasia representing the various Australian jurisdictions. Thematic analyses revealed that a range of resource, environmental, staff and patient factors contribute to difficulties in managing mental health patients. Solutions suggested by interviewees included improved resources, ED redesign and improved links to resources outside the ED. An overwhelming majority of participants perceived the need for more educational opportunities in mental health. Conclusion: Although the provision of timely and quality care is expected for all patients attending EDs, there exist multiple barriers to provision of adequate care for ED patients presenting with mental illness. Many of these are systems‐based and thus require systems‐based solutions. ED clinician's perceive that improved educational opportunities in mental health, however, might alleviate some barriers they face. Consideration should be given to a comprehensive, quantitative mental health‐related learning needs analysis of ED clinicians.     

Promoting Resilience and Recovery in a Buddhist Mental Health Support Group

Communities of faith are important arenas for psychiatric mental health nurses to promote emotional well-being and support recovery for persons with mental health problems. This article describes an innovative faith-based mental health group, based on Buddhist philosophy and practice and established by an advanced practice psychiatric nurse, that uses psychoeducation, peer support, and faith encouragement to help participants find hope and meaning in the experience of mental health problems. A brief overview of Buddhism and selected concepts relevant to the philosophical framework of the Buddhist mental health support group is followed by a review of the common themes of the group discussions. These include: finding value in the illness experience; differentiating the proper role of treatment from that of Buddhist practice in optimizing mental health; and experiencing a deeper sense of joy, despite current suffering.     

The Physical Health of Individuals Receiving Antipsychotic Medication: A Qualitative Inquiry on Experiences and Needs

Individuals with a mental illness are reported to have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as cardiovascular disease and Type 2 diabetes. This inquiry sought to identify the physical health beliefs, experiences and needs of individuals with mental health problems in receipt of antipsychotic medication who live in the community. A qualitative inquiry was undertaken using three focus groups in a community mental health service in Ireland with 21 participants with mental health problems who were treated with antipsychotic medication. The participants were clear about the importance of good physical health as well as good mental health. They disliked the adverse effects of antipsychotic medication and experienced many barriers in accessing general practitioners/primary care services. They also preferred to receive health advice and self-management advice from the mental health services. The participants in this study were aware of the need to engage in health protective behaviours but were often overwhelmed by their comorbid health issues and the organizational and communication barriers in accessing their general practitioners.     

A qualitative exploration of barriers and motivators to physical activity participation in women treated for breast cancer

Abstract

Purpose: The adoption and maintenance of a physically active lifestyle among women after breast cancer is an important priority for public health and rehabilitation science. The purpose of this qualitative study was to explore breast cancer survivors’ perceptions of the factors influencing their ability to maintain a self-directed physical activity program. Method: Nine women participated in semi-structured, in-depth interviews. Data were coded into perceived barriers and motivators to maintenance of physical activity using thematic analysis. Results: Women identified a range of physical (e.g. cancer-related physical symptoms), environmental/organizational (e.g. bad weather, lack of equipment/facilities, lack of knowledge, time constraints) and psychosocial (e.g. lack of motivation, low social support, low confidence/skill) barriers. They also identified perceived physical (e.g. weight management, health improvement or maintenance, increase energy) and psychosocial (e.g. improve body image, experience enjoyment, social support, positive emotions) motivators. Conclusions: These findings are consistent with research on barriers and motivators to physical activity initiation, and can be used to develop self-directed physical activity programs that target active breast cancer survivors to sustain regular engagement. Furthermore, the barriers and motivators identified represent key variables for further investigation.

• Implications for rehabilitation

• The present study identifies a number of perceived physical, psychosocial and organizational/environmental barriers to naturally occurring physical activity participation among active breast cancer survivors that should be addressed to ensure they maintain a physically active lifestyle

• This study also provides evidence that comprehensive approaches that address physical and psychosocial motivators to physical activity should be developed to assist women with a history of breast cancer maintain their physical activity levels

     

Cardiovascular Health Promotion and Consumers with Mental Illness in Australia

People with serious mental illness (SMI) have increased risk of cardiovascular disease and premature death, yet research on nurse-provided health promotion in mental health services remains under-developed. This paper informs efforts to improve the nursing role in physical health of consumers with SMI by establishing what nurse perceptions and background influence their care. Members of the Australian College of Mental Health Nursing were invited to participate in an online survey on their views on physical health care in mental health services. Survey questions included: (a) nurse–consumer collaboration in preventative care and (b) sub-sections of the Robson and Haddad Physical Health Attitude Scale to measure nurse perceived barriers to encouraging lifestyle change of consumers with SMI and frequency of nurse physical healthcare practices. Structural equation modelling was applied to investigate antecedents to physical health care, as well as relationships between antecedents. A national sample of 643 nurses reported regular engagement in health promotion (e.g. advice on diet). There was statistical support for a model depicting perceived consumer–nurse collaboration as a dual-determinant of nurse perceived barriers and self-reported health promotion to consumers with SMI. Perceived barriers to consumer lifestyle change did not predict health promotion. The effects of nurse–consumer collaboration were significant, but small. Perceived consumer–nurse collaboration in preventative care may positively influence the amount of health promotion by nurses in mental health. Perceived barriers to consumer adherence with a healthy lifestyle did not have an impact on nurse-delivered health promotion.     

Nothing is going to stop me now: obstacles perceived by low-income women as they become self-sufficient

As low-income women struggle to become self-sufficient, they encounter many obstacles. The literature identifies physical and mental health problems, inadequate childcare, inadequate occupational skills, lack of transportation, criminal histories, and limited educational abilities as major barriers to be overcome in this transition. Qualitative data collected from low-income women attending Innovative Alternatives for Women, an occupational skills and health information training center which was developed and implemented by a nurse, refutes several of the previously identified obstacles. Inadequate childcare and transportation were not seen as barriers to success by the program participants, but were viewed as socially acceptable reasons for not working. Eight obstacles were identified by the program participants as being the real reasons for their lack of success. The identified obstacles included the following: lack of self-esteem, especially relating to school; "bad" relationships with men; lack of support from family and friends; limited life options; lack of training for nonwelfare recipients; lack of quality programs; criminal histories; and fear of success.     

Barriers to community integration for participants in community-based psychiatric rehabilitation

This pilot study examined barriers to community integration for adults with serious mental illness (SMI) enrolled in a community-based psychiatric rehabilitation program. Program staff administered a self-report scale to 135 adults (mean age = 43.3 years, 53% men, 65.1% White). Staff completed the same measure. Individuals with mental illness and staff differed significantly in their reports of the type, number, F (1, 73) = 29.25, P < .0001, and severity (F (1, 176) = 43.53, P < .0001) of barriers to community integration. Clinicians should assist adults with SMI to identify relevant barriers, and participate in treatment planning and outcome evaluation.     

Benefits and risks of psychiatric medications during pregnancy

Traditionally, psychiatric medications were withheld during pregnancy because of fear of teratogenic and other effects. The emergence of evidence of the safety of most commonly used psychiatric medications, the availability of this information in the form of online databases, and the documentation of the adverse effects of untreated maternal mental illness have all increased the comfort of physicians and patients with respect to the use of psychiatric medications during pregnancy. The tricyclic antidepressants and fluoxetine (Prozac) appear to be free of teratogenic effects, and emerging data support similar safety profiles for the other selective serotonin reuptake inhibitors. The mood stabilizers appear to be teratogenic. With the exception of the known risk for depression to worsen in the postpartum period, there is little consistent evidence of the effects of pregnancy on the natural history of mental illness. Decisions regarding the use of psychiatric medications should be individualized, and the most important factor is usually the patient's level of functioning in the past when she was not taking medications.