Themes of effective coping in physical disability: an interview study of 26 persons who have learnt to live with their disability

The aim of this study was to gain a deeper understanding of effective coping in physical disability and/or chronic illness. Twenty-six well-adjusted adults with various disabilities were interviewed. The interviews focused on how they perceived they had managed to master problems encountered by their disability and their personal views about how one should act and think to manage a life with a disability. The protocols were content analysed according to grounded theory. Five categories were extracted--self-trust, problem-reducing actions, change of values, social trust and minimization. These categories clustered around two broader bipolar constructs--acknowledgement of reality vs. creation of hope and trust in oneself vs. trust in others. The different themes of coping complemented each other and tended to be used in different contexts in a flexible manner. Both the extracted categories and the core concepts have been extensively described in the coping literature, supporting their validity. The importance of understanding coping processes from the disabled's point of view is discussed.     

The perceptions of Taiwanese families who have children with learning disability

Aims and objectives. To explore the perceptions of families in Taiwan of living with a child who have learning disability and the parents perspectives on the cultural influences on their spiritual experiences. Background. Traditionally, the family is the most important unit of society, family functioning is a key field of interest among helping professionals who provide family interventions. Design. This study adopted qualitative research with semi‐structured interviews. The study analysis used content analysis which was a process of identifying, coding and categorizing the themes in the data. Methods. Semi‐structured interviews were conducted with 117 parents in their homes and were interpreted by using content analysis to extract key conceptual themes from the transcribed interview texts. Results. The findings revealed that the perceptions of families with learning disability children were wide‐ranging. The stressors did not occur in a fixed order, they were different in degree and importance from one family to another. Conclusions. The results showed that the experience of analysing qualitative data was extremely valuable for parents in that it aided their own understanding of the real‐life experiences of the parents and in coming to know the parents in a richer, more meaningful way. In doing so, nurses need to be aware of their own thoughts and environment without letting it influence others. Relevance to clinical practice. The nurse should demonstrate knowledge and understanding of the family's culture and be able to show respect for cultural difference to assess and identify culturally acceptable health‐care interventions.     

Impact of an education programme for staff working with children undergoing painful procedures

AIM: Needle phobia is very common in children, particularly in those with chronic illness who may have to endure many painful procedures. A programme developed to educate paediatric healthcare professionals working with children undergoing painful procedures was evaluated to identify: (1) whether the education programme led to an increase in participating clinicians' knowledge and confidence; and (2) the effectiveness of the education programme in changing practice for patient care. METHOD: Five senior house officers undertook the one-hour training provided by the hospital play specialist. Questionnaires were completed by the clinicians at the beginning and end of the programme. Nurses reported on the clinicians' adherence to best practice. Twenty-one children who had undergone painful procedures were interviewed with their parents to assess their levels of pain, distress, satisfaction and coping style. RESULTS: Participants had increased their knowledge of how to work with children undergoing painful procedures. The main changes in knowledge reported by the clinicians were involving the nurse and the play specialist, preparing the equipment out of sight of the child and using distraction techniques. Parents and children reported low levels of distress during painful procedures, high levels of satisfaction with the procedure and listed a number of coping strategies that helped the child, and the parent, to cope during the procedure. Staff reports indicated that the protocol for painful procedures and that techniques such as distraction were being used in the majority of cases to help the child to cope. CONCLUSION: There are useful pain control techniques that can be taught relatively quickly by nursing staff to paediatric healthcare professionals that do make a substantial difference to the care of children.     

Relationship between use of technology and employment rates for people with physical disabilities in Australia: Implications for education and training programmes

This study examined the impact of computer and assistive device use on the employment status and vocational modes of people with physical disabilities in Australia. A survey was distributed to people over 15 years in age with physical disabilities living in the Brisbane area. Responses were received from 82 people, including those with spinal cord injuries, cerebral palsy and muscular dystrophy. Of respondents 46 were employed, 22 were unemployed, and 12 were either students or undertaking voluntary work. Three-quarters of respondents used a computer in their occupations, while 15 used assistive devices. Using logistic regression analysis it was found that gender, education, level of computer skill and computer training were significant predictors of employment outcomes. Neither the age of respondent nor use of assistive software were significant predictors. From information obtained in this study guidelines for a training programme designed to maximize the employability of people with physical disabilities were developed.     

Improving decision-making in caring for people with epilepsy and intellectual disability: an action research project

Title. Improving decision‐making in caring for people with epilepsy and intellectual disability: an action research project. Aim. This paper is a report of an action research study aimed at improving decision‐making concerning risks in people with epilepsy and intellectual disability and the empowerment of participants to sustain this improvement. Background. Residents of long‐stay units in specialized epilepsy centres suffer severe epilepsy and are often intellectually disabled. Professional caregivers have to find a balance between risk‐taking and protection, as both can have a negative effect on quality of life. Clients, their representatives and caregivers are involved in this decision‐making process. Method. A participative action research project was conducted. Data were gathered continuously over a 22‐month period in 2004–2006 by interviews, observation, written reports of meetings and personal stories. Findings. The action research resulted in an ongoing process of improvement. Problems in decision‐making about risk were clarified. The importance of consensus about risks and commitment to risk management between all involved became apparent. Phases in risk management were discerned and used to adjust caregiving to clients’ needs and capacities Assessment of client risk became more systematic and ‘steps to an individual framework for decision‐making’ were developed as a tool for a systematic approach. Conclusion. Using an action research model to improve decision‐making provided the preconditions for improving decision‐making and risk management and suggesting a way to improve this process in this and other institutions.     

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community‐based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.     

Reflections on the education and training of mental health staff who work with women who have been sexually abused in childhood

Strategies to reduce sexual assault on women patients in mental health inpatient acute wards have included effective policies, a consistent approach to recording and monitoring data relating to incidences of sexual assault, increased staff levels and improvements in the ward layout. A series of workshops were devised to enable mental health staff to work with greater awareness and sensitivity to keep women patients safer on inpatient wards. What emerged in particular during the training was the ways in which staff felt at loss as to how to build therapeutic relationships with women patients, particularly those with histories of sexual abuse. These patients may repeat early ways of relating which may at times be a challenge for the staff caring for them. This paper suggests that psychoanalytic insights offer an understanding of these ways of relating. This can be combined with frequent and supportive supervision to enable staff to safely articulate their often troubling responses to caring for women patients, this creating a caring and supportive environment for staff.     

Using assistive technology for schoolwork: the experience of children with physical disabilities

Aim.?This study explored the experience of children with physical disabilities using assistive technology for participation with schoolwork to gain a greater understanding of their perspectives and subjective experiences.

Method.?A qualitative study involving thematic analysis of in-depth interviews of the child with a parent or significant adult. Purposeful sampling from a larger study recruited five children aged between 10 and 14 years, with differing physical disabilities who attended mainstream schools. All children used computer-based assistive technology.

Results.?All of the children recognised that assistive technology enabled them to participate and reduced the impact of their physical disability, allowing independent participation, and facilitated higher learning outcomes. Issues related to ease of use, social implications and assistive technology systems are discussed.     

Nursing staff members' intentions to use physical restraints with older people: testing the theory of reasoned action

AIM OF THE STUDY: To examine nursing staff members' attitudes, subjective norms, moral obligations and intentions to use physical restraints, using the Theory of Reasoned Action (TRA). RATIONALE: During the last two decades an extensive body of research has examined nurses' attitudes as one of the main factors affecting the decision to use or not to use physical restraints with older persons. However, no studies have examined empirically the antecedents to nurses' intentions to use physical restraints within a theoretically based framework. METHOD: A correlational design was used with 303 nursing staff members from an 800-bed elder care hospital in central Israel. Participants completed a questionnaire including questions based on the TRA as well as socio-demographic and professional characteristics. RESULTS: Regression analyses found attitudes, subjective norms and moral considerations to be significantly associated to intention to use physical restraints with older people. The TRA explained 48% of the variance in nurses' intentions. CONCLUSIONS: The TRA proved to be a useful framework for examining nurses' intentions to use physical restraints. Nurses' attitudes, beliefs and expectations of significant others should be examined before implementing educational programmes regarding the use of physical restraints.