Evaluation of a bibliotherapy manual for reducing psychological distress in people with depression: a randomized controlled trial

Aim. This article reports a study to evaluate the efficacy of a self‐help manual in reducing psychological distress in individuals with moderate depression. Background. The prevalence of depression in Thailand is increasing markedly (e.g. from 56–197 per 100,000 population between 1997–2007). Design. We conducted a randomized controlled trial with 54 outpatients with depression in Chiang Mai Province in Thailand. Method. Participants were assigned randomly to an intervention or control group. The intervention group participants were given a self‐help manual in addition to standard care and treatment while the control group received standard care and treatment. Psychological distress was measured with the Kessler Psychological Distress Scale. Data were collected between October 2007–April 2008. Results. The findings showed statistically significant differences between both groups in their levels of psychological distress (e.g. tiredness, hopelessness, restlessness). At post‐test, the distress scores of the intervention group were lower than those in the control group. Between post‐test and 1‐month follow‐up, distress scores continued to decrease steadily in the intervention group but only decreased slightly in the control group. Conclusion. The findings affirm the benefits of bibliotherapy or self‐help therapy in book form in helping to reduce psychological distress in people with moderate depression. The approach is easy to use and can be incorporated as an adjunct to standard care and treatment. Bibliotherapy can be used by community mental health nurses and other clinicians to reduce psychological distress and promote recovery in people with moderate depression.     

Listening as a method of addressing psychological distress

Aims  This paper discusses the values of therapeutic listening and ways that emotional difficulties can impact palliative nurses' abilities to provide psychological care.
Background  Recent literature indicates that providing psychological care can burden some healthcare professionals including nurses; who may lack the necessary competencies or organizational resources to carry out their roles.
Evaluation  References drawn from the databases: all EBM reviews, BRITISH NURSING INDEX, CINAHL, PSYCH INFO and MEDLINE and EMBASE are discussed.
Key issues  Psychological care is considered critical to providing holistic care. Yet the literature suggests engaging in such work makes emotional demands on the professionals attempting to carry it out and is associated with psychological difficulties including burnout.
Conclusion  Clinical supervision can help reduce the distress caused by emotionally charged situations. Thoughtful clinical supervision can also contribute to safe and effective health care.
Implications for Nursing Management  Nursing would benefit from understanding more about the effects on healthcare professionals of repeated exposure to emotionally charged situations and benefits that clinical supervision can offer to health care.     

Towards a rhetoric of spirituality in mental health care

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.     

Psychological and Symptom Distress In Terminal Cancer Patients with Met and Unmet Needs

This study identified the needs of terminal cancer patients, investigated the factors associated with unmet needs, and assessed psychological and symptom distress associated with unsolved needs. Ninety-four patients were randomly selected from 324 patients admitted for palliative care in 13 Italian centers. Two self-administered questionnaires (the Symptom Distress Scale and the Psychological Distress Inventory) were administered to all the patients. Patients needs were identified using a semi-structured interview, aimed at exploring five areas: physiological needs, safety needs, love and belonging needs, self-esteem needs, self-fulfilment needs. A content analysis of the answers defined 11 needs, and identified patients with unmet needs. The most frequent unmet needs were symptom control (62.8%), occupational functioning (62.1%), and emotional support (51.7%). The less frequently reported needs were those related to personal care (14.6%), financial support (14.1%), and emotional closeness (13.8%). Low functional state was significantly associated with a high proportion of patients with unmet needs of personal care, information, communication, occupational functioning, and emotional closeness. Patients with unmet needs showed significantly higher psychological and symptom distress for most needs. This study provides some suggestions about the concerns that should be carefully considered during the late stage of cancer.     

Mental health nurses' perspectives of people who self‐harm

Self‐harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self‐harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self‐harm. Data were collected using semi‐structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self‐harm: (i) Nurses’ level of preparedness to work with people who self‐harm; and (ii) The healthcare system. Several sub‐categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self‐harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self‐harm and an accurate understanding of the functions of self‐harm focuses therapeutic interactions to manage psychological distress and reduce further self‐harm and lessen the risk of suicide.     

Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses

BACKGROUND: Stress-related outcomes of job satisfaction and absenteeism among nurses should receive more attention in Hong Kong because absenteeism is costly. Many nurses' complaints are due to organizational change in privatization since the establishment of the Hong Kong Hospital Authority in 1991. Organizational climate is found to be an antecedent of job dissatisfaction and absenteeism in many studies in western societies. AIM: To investigate the role of organizational climate and psychological distress on job satisfaction; and the role of climate, distress and job satisfaction on absenteeism in Hong Kong nurses, while controlling for demographic variables. METHODS: A self-administered questionnaire survey method was used to collect data from two samples of nurses within a 8-month period. They are, respectively, 144 (74 general nurses, 70 psychiatric nurses; 47 males, 97 females) and 114 (85 general nurses, 29 psychiatric nurses; 17 males, 97 females) nurses. RESULTS: Multiple regression analyses revealed that occupational type (psychiatric/general), environment (the physical conditions in the work area) and psychological distress were significant predictors of job satisfaction for sample 1; and well-being (social relations, welfare and health issues) was the only significant predictor of job satisfaction for sample 2. However, age, involvement (the degree of commitment displayed towards employees by the organization), psychological distress and job satisfaction were significant predictors of absenteeism for sample 1; and occupational type, organization (the interaction between the worker and the organization), and involvement were significant predictors of absenteeism for sample 2. CONCLUSIONS: The empirical findings provide support for the climate-job satisfaction and climate-absenteeism relationships. Psychological distress could be an antecedent of job satisfaction; and job satisfaction could be an antecedent of absenteeism. Certain climate dimensions should be improved to enhance job satisfaction and reduce distress, which in turn will reduce absenteeism.     

Predictors of psychological distress in chronic pain patients

The purpose of this study was to identify sources of psychological distress in patients attending pain clinics. Patients attending two pain clinics in the UK completed a self-report assessment questionnaire which included a 12-item, 5-point semantic differential measure of psychological well-being/distress, together with a range of single-item measures of pain and psychosocial factors measured using 5-point verbal report scales. Multiple regression analysis identified that 60% of the variance associated with psychological distress was explained by a combination of fears about the future, regrets about the past, age (younger people were more distressed), practical help (more help was associated with more distress), feeling unoccupied and personal relationship problems. These results support previous findings which have suggested that a significant proportion of the emotional disturbance in chronic pain patients is associated with psychosocial factors which are either secondary to, or concurrent with, the pain. The method described provides a simple and quick method of assessment which may be used by nurses in clinical settings to identify sources of psychological distress in patients with chronic pain and opportunities for therapeutic intervention.     

Psychological consequences of bullying for hospital and aged care nurses

RODWELL J. & DEMIR D. (2012) Psychological consequences of bullying for hospital and aged care nurses. International Nursing Review Aim: This study examines the psychological consequences of workplace bullying by negative affectivity (NA) and demographics for hospital and aged care nurses. Introduction/Background: Nurses are particularly vulnerable to workplace bullying, with suggestions that oppressed group behaviours may play a role. Bullying is a potent stressor that can negatively impact psychological well‐being, which, with NA and demographics, may be important in understanding the consequences of nurse bullying. Such factors are yet to be examined together across different nursing contexts. Methods: A cross‐sectional survey was conducted across hospital and aged care nurses working within a medium to large Australian healthcare organization in October 2009. The sample comprised 233 (29.1%) hospital and 208 (43.8%) aged care nurses. Analyses of covariance were used to evaluate the data. Results: For hospital nurses, psychological distress was noted as an impact of bullying, while depression was the impact for aged care nurses. Full‐time aged care nurses reporting bullying had higher psychological distress scores, compared with part‐time workers in the same area. NA was a significant covariate across both outcomes in both contexts. Discussion/Conclusion: This study demonstrates that bullying has detrimental consequences for the mental health of nurses in both hospital and aged care contexts. The results support the suggestion that nurses are an oppressed group at high risk of bullying, confirm the intrinsic nature of NA to the bullying process, and highlight the importance of employment type for aged care nurses. Given the shortage of nurses, managers need to give higher priority to addressing workplace bullying and implementing zero tolerance policies.     

Sleep patterns and psychological distress in women living in an inner city

Psychological distress, including symptoms of anxiety, depression, and psychological trauma, is common in women living in inner cities and can be associated with disturbed sleep. The purposes of the study of 115 women were to examine: (a) objective and subjective sleep patterns; (b) extent of psychological distress; and (c) the relationship between objective and subjective sleep patterns and psychological distress. Wrist actigraphs were worn. High levels of life stress, sleep pattern disturbance, and psychological distress were common. Self‐reported sleep patterns, but not objective sleep pattern variables, explained 12.5% to 44% of the variance in psychological distress, suggesting the importance of screening for sleep and psychological distress. These findings suggest that interventions focusing on sleep or psychological distress may reduce symptoms. © 2008 Wiley Periodicals, Inc. Res Nurs Health 32:177–190, 2009     

Symptoms of depression and stress mediate the effect of pain on disability

The mechanism or mechanisms involved in the development of pain-related disability in people with low back pain is unclear. Psychological distress has been identified as one potential pathway by which an episode of pain influences the development of persistent disabling symptoms; however, the relationship has not been formally investigated. This study investigated the causal relationship between pain and disability via psychological distress (and its components depression, stress, and anxiety) by using mediation path analysis. The study sample included 231 participants with subacute low back pain (6 to 12 weeks’ pain duration) who had been recruited for an exercise-based randomised, controlled trial. All participants completed self-report assessments of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), and psychological distress (Depression Anxiety and Stress Scale) at baseline and again at 2 follow-up time points (6 and 12 weeks after baseline). The results of the mediation analysis suggest that approximately 30% of the relationship between subacute pain and later disability is dependent on the level of patients’ psychological distress. The finding that psychological distress only partially (30%) mediated the pain-disability relationship indicates that other factors should also be explored. Further analysis into the components of psychological distress revealed that the symptoms of depression and stress, but not anxiety, are responsible for mediation of the pain-disability relationship. These findings provide an opportunity to decrease the risk of long-term disability through early identification and management of depressive and stress symptoms.     

Understanding persons with psychological distress in primary health care

The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23–51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self‐esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self‐esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person‐centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well‐being.     

Moral distress, advocacy and burnout: Theorising the relationships

Burnout is a major contributor to shortages of experienced nurses. The research literature shows a correlation between moral distress and burnout in critical care nurses. This paper reports on part of an interpretive interactionist study concerning nurses' experiences of moral distress which prompted attempts to advocate for vulnerable patients. One critical incident is used as an example of the qualitative findings of the study. In this paper, we theorise about what happened when nurses advocated for their patients by challenging medical treatments which the nurses believed to be both inappropriate and to contributing to patient suffering. When attempts at advocacy were unsuccessful, the nurses experienced intensified moral distress, frustration and anger. Being an unsuccessful advocate resulted in nurses being relocated within the hospital, nurses being scapegoated and/or burning out. The theoretical links which this paper makes between advocacy, moral distress and burnout are supported by empirical data from the study.     

Examining pain-related distress in relation to pain intensity and psychological distress

Despite frequent use of the term symptom distress in the pain literature, symptom distress is often confused with symptom intensity and psychological distress, contributing to inadequate assessment of symptoms and less than ideal symptom management. In this article we address these issues and propose a hybrid model, combining Price's interaction of pain sensation, pain unpleasantness, and secondary pain affect model with an information processing model. Recommendations on methods and techniques to reduce this confusion would assist healthcare professionals and researchers to better distinguish among these terms as they manage patient symptoms and design symptom management studies. Thus, the purpose of this article is to examine the terms symptom distress, symptom intensity, and psychological distress using pain as the example symptom.     

Person-centredness: a concept analysis

Person-centred care is a term that has been used frequently in literature since the mid-1990s. This type of care requires health care staff to use person-centredness as a focus for developing relationships and plans of care. In an attempt to define person-centredness, a literature review was undertaken as a means of developing a concept analysis. This led to profiling attributes of person-centredness developed from the work of early theorists and authors as they began to recognise the importance of the ethical and legal rights of people and the importance of holistic care in maintaining wellbeing. However, in the literature, the term person-centred was often interchanged with terms such as patient or client-centred which may lead to confusion. This concept analysis shows that many of the attributes of person-centredness are indeed relevant to patient and client centred care. However, the connotations behind client and patient may appear to shift the balance of power to the health carer by concentrating on the illness rather than the person. Therefore, clarification of the term person-centredness may assist future researchers, practitioners and authors to apply one term only until evolution leads to further definition or change.     

Emotional communication with older people: A cross‐sectional study of home care

The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio‐recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65–84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.     

正念减压疗法在癌症患者心理困扰中的应用进展

癌症患者普遍存在心理困扰,正念减压疗法(mindfulness-based stress reduction,MBSR)因具备诸多优势而被广泛用于肺癌患者心理困扰的干预。本文介绍了癌症患者心理困扰及MBSR的相关知识、MBSR在癌症患者心理困扰中的应用以及MBSR用于癌症患者心理困扰的机制。     

Identification of risk factors for moral distress in nurses: basis for the development of a new assessment tool

This article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.