Experiences of social support among participants in self-help groups related to coronary heart disease

• ? Self-help groups for coronary heart disease (CHD) patients were initiated by the Swedish National Association for Heart and Lung Patients in co-operation with Halland University College of Caring Science. Professional support was given in the form of a guidebook with health advice to be used at group meetings.
• ? The aims of this study were to describe the experiences of social support and the effects of health advice among people suffering from CHD and their next-of-kin participating in self-help groups.
• ? A questionnaire was developed containing three scales with questions about social support in connection with group participation and the effects of health advice shared during the programme.
• ? The results showed that 84% of participants knew about risk factors; all group members had changed their attitudes in some way concerning their life-style and 65% thought that they had changed their daily life activities as a consequence of the group participation. Most participants had experienced social support, through both support received (82%) and their own ability to provide support (7.1, scale range 0–10).
• ? In self-help groups layman support is the most effective kind of support, but the results indicate that health professionals also have an important role to play. In future research and clinical planning of rehabilitation of people with CHD, self-help groups, both from a human and economic point of view arc well worth considering.

     

'From victim to agent': the clinical and social significance of self-help group participation for people with life-threatening diseases

AIM: The main objective of the paper is to discuss the ways in which self-help groups can be useful to persons with life-threatening diseases like cancer or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The paper offers an outline of the central characteristics of self-help groups, highlighted by the participants themselves. BACKGROUND: Self-help groups are a growing phenomenon across national borders. New empirical sociological studies show that nurses have become important agents in self-help groups, both within and outside the public health-care system. However, research on self-help groups is a relatively new area within nursing studies yet it serves an important function in shedding light on a rather unique form of social practice organized and managed partly by the participants themselves. METHODS: Qualitative interviews designed to examine how participants evaluate their experiences with self-help groups. The study includes 53 self-help group participants suffering from cancer or HIV/AIDS. Findings: Contact with other people, forming of friendships, new networks and increased self-confidence are some of the effects indicated by the participants. Participation in a self-help group has a positive impact on the patients' ability to cope with the psychological and social consequences of living with a life-threatening disease. CONCLUSIONS: It is evident that the positive effects of self-help groups are mainly because of their inherent capacity for universalizing personal problems, which, in itself, legitimizes the scientific relevance of self-help groups. There is no evidence to indicate that self-help groups have a positive influence on the life expectancy of participants who suffer from cancer or HIV/AIDS, but it should be noted that this is not the explicit concern when groups are formed. By their very existence self-help groups indicate the need for a reevaluation of the scope and focus of the individualized care and nursing. The clinical and social significance of self-help group participation has not been sufficiently accounted for.     

User involvement in health and social care education: a concept analysis

This paper presents an evaluative discussion of the literature, and findings from a concept analysis which explores user involvement in the context of health and social care higher education in the United Kingdom. User involvement is increasingly a requirement in higher education and the purpose of the concept analysis was to clarify and elucidate the meaning and nature of the concept. Walker and Avant's (2005) eight step framework for concept analysis was used to provide understanding of the underlying attributes and a model for critique and meaningful evaluation and research. A structured search and discussion of contemporary literature was undertaken. A model case is identified along with antecedents, critical attributes and consequences. The complexities of involvement are delineated with a recommendation for robust research that explores the benefits of involvement.     

Mental health policy and integrated care: global perspectives

Although omitted from the World Health Organization's eight Millennium Development Goals, mental illness ranks fourth of the 10 leading causes of disability in the world and is expected to approach second place by 2020. Scarce resources challenge responses to mental health needs. Effective approaches must consider existing healthcare delivery networks, nurses as care providers, as well as social, cultural, political and historical contexts. This paper reviews policy development and care approaches to address mental health needs around the world. Challenges, successes and further needs are discussed. Selected articles were reviewed to represent varied approaches to address mental health needs in countries with diverse resources and infrastructures. Integrated systems offer one model for addressing mental health needs along with physical health needs within a population. While potentially an efficient strategy, caution is advised to ensure services are integrated and not merely added on top of an already overburdened system. As the largest group of healthcare professionals worldwide, nurses play a key role in the delivery of mental health services. Nurses have an opportunity, if not a responsibility, to collaborate across borders sharing education and innovative approaches to care delivery.     

Nurses and English primary care groups: their experiences and perceived influence on policy development

AIMS OF THE STUDY: To investigate the experiences and perceived influence of nurses serving on English primary care group boards. BACKGROUND: The development of the nursing workforce and nursing services in primary care have been piecemeal and nurses have not always contributed to policy development. The recent establishment of primary care groups (PCGs) in the United Kingdom (UK) potentially offers nurses the opportunity to take a concerted and strategic role in developing professional roles and planning service developments. RESEARCH METHODS: As part of a longitudinal study of a 15% random sample of English primary care groups, nurse board members were surveyed in the winter of 1999. One hundred and forty-four nurses were invited to return self-completion questionnaires. RESULTS: Completed questionnaires were returned by 106 of those invited to participate (73%). Respondents reported that combining their usual work with their role in the PCG was frequently difficult. Only 26% perceived that they had been well prepared for their new role. Compared with other board members [for example, general practitioners (GPs)], nurses perceived that their own influence was limited, with only a quarter rating the influence of nurses on decision-making as great. Most of the sample were feeding back information to other primary care and community nurses working in the locality and 52% rated communication with this wider constituency as good or better. Nurse board members were enthusiastic about their role and optimistic about the positive future impact of PCGs on health. CONCLUSIONS: PCGs are still at a relatively early stage in their development. It is still too early to assess their impact on nurses working in primary care and community settings. Board membership offers nurses a voice in local health policy development.     

Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm

Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end-of-life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden. The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3-day seminar in multicultural end-of-life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post-training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end-of-life care; 3) post-training reflections about one's own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end-of-life care. One of the study's main findings was that to better understand other cultures it is important to raise awareness about the staff's own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.     

Social networks and best practices in public health: the example of regional billing groups

OBJECTIVE: Rising health care costs, increased demand for clinical services, and reimbursement difficulties created a funding shortage among local health departments in the state of Kansas. This intervention established regional billing groups to provide professional support and increase third-party reimbursement. DESIGN: Through feedback sessions, billing clerks provided qualitative responses about training needs. These informed the process of establishing billing groups in each state health district. SAMPLE: All billing clerks in the state's 6 regional health districts were invited to participate, as were insurance and billing software representatives. INTERVENTION: Between April 2002 and September 2004, 6 collaborative groups were established. Billing clerks received professional support and training from peers, insurance representatives, and software providers. An interagency billing advisory team was established to coordinate training activities between groups. RESULTS: These groups have allowed local health departments to increase reimbursement revenue by 50%-75%, allowing for the provision of expanded health services to client populations. CONCLUSIONS: These methods can serve as a model for other states, particularly those with considerable rural populations or decentralized health care systems. Still, funding shortages persist, and public health billing clerks will continue to need ongoing training in the most current and effective billing methods.     

Being and doing politics: an outdated model or 21st century reality?

Title. Being and doing politics: an outdated model or 21st century reality?. Aim. This paper presents a discussion of how critical social theory can be used as a tool for research, reflection and exploration of the political role of the nurse. Background. Sociological theory can be used to examine ideologies within nursing systems in order to contribute to the future development of the profession. The importance of critical social theory has been identified in the literature as being directly relevant to holism which is central to the nature of nursing. Data sources. Texts published in English were identified from 1990 to 2008 using the keywords critical social theory, community nursing, political advocacy, social justice, sociological theory, health inequalities, health democracy, equity and inequality. Discussion. Critical social theory can be used as a tool to highlight ethical ways to practise nursing. One reason for examination of the community nurse’s political role is a shift in focus from the individual as patient to communities experiencing health inequalities. Nursing needs to decide whether the profession will work at the political level, and where advocacy and citizenship are located within a community role. Conclusion. Nurse educators must prepare nurses for political participation, and nurse managers need to focus on national and local contexts in order to encourage policy analysis and community engagement within nursing practice. An understanding of critical social theory can aid decision‐making in relation to global and local policy, enable the nursing profession to respond to social injustice, and permit nurses to work with communities in the pursuit of community health.     

Illicit drug users in Northern Ireland: perceptions and experiences of health and social care professionals

Over the 30 years of conflict, Northern Ireland escaped the worst excesses of illegal drug trafficking and usage. This was in large part due to the 'policing' of local community crime by paramilitaries. However, since the first 'cease-fire' in 1994 the province has witnessed a dramatic and unprecedented rise in the availability of illicit drugs. This increased availability reflects rising consumption of these drugs in the province. The aim of this study was to explore the perceptions that a sample of health and social care professionals' hold of illicit drug users in Northern Ireland. A survey methodology was used. Community settings across Northern Ireland were accessed. Focus groups and face-to-face interviews were used as data collection methods. Thirty-five health and social care professionals took part in this study. Thirty-two took part in six focus groups; three respondents underwent one-to-one interview. The participating professionals reported to have little or no education or training in the care and treatment of illicit drug users. Some stated that they would reject the offer of education and training in this area to prevent contact with illicit drug users. Many displayed strongly negative views of this client group, often expressing a preference not to care for or treat these people, preferring all their care to be given by specialists in illicit drug treatment. These findings indicate that most of the health and social care professionals who took part in this study appear unprepared and unwilling to meet the challenge of caring for illicit drug users. The findings will be of interest to service providers within and outside the UK.     

Overview and critique of judgement and decision making in health care: social and procedural dimensions

This paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.     

Perceptions of professional clinicians and non-clinicians on their involvement in strategic planning in health care management: implications for interdisciplinary involvement

Abstract There is increasing emphasis on interdisciplinary involvement by health care managers. The objective of the present paper was to identify the level of involvement that middle manager heads of department have in strategy development in acute care hospitals in Ireland, and to identify if professional clinicians were more involved than non-clinicians. Twenty-five interviews were undertaken. Findings indicated that middle managers were strategically involved and that non-clinicians perceived that they were more involved in strategy development than professional clinicians. Strategic involvement appeared to result from a higher level of strategic awareness and confidence by non-clinicians in the process. Professional clinicians perceived that their expertize was not recognized or appreciated by non-clinicians or by senior management. Agreement of strategy amongst both groups is critical, as exclusion will lead to demotivation and consequent deterioration in health care delivery.     

Health and social care management for older adults with multimorbidity: a multiperspective approach

Multimorbidity, a condition common among older adults, may be regarded as a failure of a complex system. The aim of this study was to describe the core components in health and social care management for older adults with multimorbidity. A cross‐sectional design included two methods: individual interviews and group discussions. A total of 105 participants included older adults with multimorbidity and their relatives, care staff and healthcare policymakers. Data were analysed using content analysis. The results show that seven core components comprise a multiperspective view of health and social care management for older adults with multimorbidity: political steering, leadership, cooperation, competence, support for relatives, availability and continuity. Steps should be taken to ensure that every older adult with multimorbidity has a treatment plan according to a multiperspective view to prevent fragmentation of their health care. This study provides relevant evidence developing a multiperspective model of health and social care management for older adults with multimorbidity.     

Coping with everyday reality: Mental health professionals’ reflections on the care provided in an acute psychiatric ward

There is little research evidence about how the mental health professionals are coping with the complexity of everyday practice in psychiatric acute care. The aim of this study was to explore mental health professionals’ reflections on their work on an acute psychiatric ward. Data were collected using participant observation and interview methods. Three core themes were identified from a qualitative hermeneutic analysis. The first core theme, coping with uncertainty, uncovered a dialectical pattern of the factors contributing to thriving and strain in the working situation. The second core theme, caring for the patient, included the caring process, patients’ pathway to acute psychiatric care, as well as the patients’ needs and roles on the ward. The third core theme, coping strategies, included five different methods the primary nursing system, concealing versus integrating, milieu therapy, seclusion and the medical orientated model. It was concluded that good mental health care is a result of collaboration between health professionals and the health services. This study highlights the need for support to professionals and for establishing structures that will enable collaboration to take place. Taken together, this may contribute to enhancing the care of the patient and their families.     

Knowledge about social networks and integration: a co-operative research project

AIM: This paper is a report of a study investigating how knowledge of social network and integration influenced mental health professionals' understanding and practice. BACKGROUND: Community mental health work focuses on people suffering from mental health problems as well as the consequences for the person involved and their family or network. There is a need to expand community mental health workers' knowledge about social networks and their functions. METHOD: A qualitative study using a co-operative research approach was used to develop participants' knowledge of social network and social integration theory. Action research has the potential to facilitate changes in the field. Data were collected using focus groups. Qualitative content analysis was employed to develop the theme and categories. The data were collected in 2004-2005. FINDINGS: The main theme identified was the potential of experiential knowledge-based competence, which was characterized by the following categories: (1) increased knowledge, (2) awareness of social interactions, (3) cross-disciplinary professionalism and (4) potential for changes in practice. Participants' knowledge and awareness of the potential of social integration as a tool for social network interventions were considerably strengthened. However, this knowledge needs to be implemented in practice. CONCLUSION: Co-operative research is an approach that can be beneficial in the public sector. To achieve the best possible results, the whole team must be involved and play an active part in all areas of the research project. If the groups involved are too large, participants' level of engagement may suffer.     

Hocus-pocus,the focus isn't strictly on locus: Rotter's social learning theory modified for health

This paper shows how the author's original modification of Rotter's social learning theory (SLT) highlighting the construct of health locus of control beliefs is no longer adequate. It develops a new modification of SLT where the internal health locus of control beliefs moderate but do not mediate health-promoting behavior. It discusses the development and utility of global indicators of perceived control over health in preference to a strict focus on the locus of the control.     

协同护理模式对社区脑卒中高危人群健康行为和自我护理能力的影响

[目的]探讨协同护理模式对社区脑卒中高危人群健康行为和自我护理能力的影响。[方法]将80例社区脑卒中高危个体随机分为干预组（40例）和对照组（40例）,干预组接受协同护理模式,对照组接受社区常规护理。以健康促进生活方式量表Ⅱ和自我护理能力测定量表评价干预前和干预6个月后高危个体的健康行为和自我护理能力。[结果]干预6个月后,干预组健康行为和自我护理能力得分与对照组相比,差异有统计学意义（P 〈0.05）。[结论]协同护理模式能提高社区脑卒中高危人群的健康行为和自我护理能力。