Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person. Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person‐centred, integrated physical and mental health care. Thus, the aim of this study was to describe mental health nurses’ experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness. Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse’s experiences. Analysis of the interviews generated three categories: (i) to have a health promotion focus in every encounter, (ii) to support with each person’s unique prerequisites in mind and (iii) to take responsibility for health promotion in every level of the organization. The results show the importance of a health promotion focus that permeates the entire organization of mental health care. Shared responsibility for health and health promotion activities should exist at all levels: in the person‐centred care in the relation with the patient, embedded in a joint vision within the working unit, and in decisions at management level.     

Translating person-centred care: a case study of preceptor nurses and their teaching practices in acute care areas

Aims and objectives. The research aims to explore how preceptors interpret, operationalize, document and teach person‐centred care as they guide students within an acute surgical environment. Background. Person‐centred care is a term that is widely used in the nursing literature; however, its interpretation in nursing practice remains virtually unexplored. This is of great significance to nurses in general but to Irish nurses in particular on whom this study is focused. As preceptor nurses have been identified as key people in the education of clinical students, it was considered important to explore how clinical preceptors promote person‐centred care to current undergraduate nursing students. Design and method. Using a case study design and a qualitative approach, six preceptors were chosen to participate in this study. Data were collected by means of participant observation, review of nursing care records and semi‐structured interviews. Data were analysed in two stages. The first stage involved the identification of themes. In the second stage data were analysed using a number of propositions to examine and explain what was gleaned from the data in the context of what was originally identified in the literature. Results. Findings highlighted that preceptors had a limited conception of person‐centred care. Measures of care reflected the medical model of nursing. Beyond that, preceptors expressed care in terms of good manners or respectful etiquette. Preceptors also had limited appreciation of what learning entails and were sceptical about classroom theory other than what they considered essential for safe practice. Conclusions. This study highlights that preceptors need both internal and external support to implement the changes advocated by the Commission in Nursing in 1998 , the Nursing Education Forum in 2000 , the Department of Health and Children in 2001 and An Bord Altranais in 2003 . Relevance to clinical practice. Person‐centred care is a relatively new concept in nursing and recommended for practice. Preceptors need facilitation with its implementation. In an effort to promote changes in the delivery of health care, it is suggested that university‐based lecturers empower students to practice evidence‐based nursing as students and subsequently as qualified nurses.     

Creating a culture of compassion: developing supportive care for people with cancer

Receiving the 2003 Distinguished Merit Award from the European Oncology Nursing Society is a great moment in my professional career. It is also a time for reflection. We can easily become immersed in the specifics of our work and forget the larger picture. An opportunity such as this allows me to step back, reflect and review what I have accomplished. It also challenges me to think about the totality of cancer nursing and cancer care, look at where we have been and about where we should be going. At the heart of this lies the concept of supportive care. I would like to consider three pertinent areas. First, I will define what I consider the domain of supportive care in cancer to be. Second, I will look at what is needed to further supportive care for people with cancer. This involves building the discipline of more rigorous symptom assessment and documentation; better management of the symptoms and concerns that confront people with cancer; moving beyond the traditional framework of treatment and care, embracing a more integrated approach; addressing quality whilst at the same expediting the delivery of supportive care services. Third, I would like to consider the challenges to reform that this presents for cancer nursing and cancer nurses. A road map for change will be presented which highlights both the necessity to promote a supportive care culture whilst simultaneously building a dedicated infrastructure of staff and services. Nurses must play a key role in supportive care. Because of our unique clinical and research base, we are primed to assume leadership roles in both these spheres. Mutual valuing, partnership and shared working are the only means of delivering enhanced cancer care. We should grasp opportunities, confident that together we have the skills and knowledge to move forward. Today is yesterday's tomorrow. We cannot do anything about yesterday, but we can do something about today to ensure tomorrow is how we want it to be. We can become what we dream, let us live that dream outside and really drive forward the care we provide for people with cancer and their families.     

Patients' perspectives of patient-centredness as important in musculoskeletal physiotherapy interactions: a qualitative study

Objective

To determine patients’ perspectives of components of patient-centred physiotherapy and its essential elements.

Design

Qualitative study using semi-structured interviews to explore patients’ judgements of patient-centred physiotherapy. Grounded theory was used to determine common themes among the interviews and develop theory iteratively from the data.

Setting

Musculoskeletal outpatient physiotherapy at a provincial city hospital.

Participants

Eight individuals who had recently received physiotherapy.

Results

Five categories of characteristics relating to patient-centred physiotherapy were generated from the data: the ability to communicate; confidence; knowledge and professionalism; an understanding of people and an ability to relate; and transparency of progress and outcome. These categories did not tend to occur in isolation, but formed a composite picture of patient-centred physiotherapy from the patient's perspective.

Conclusions and practice implications

This research elucidates and reinforces the importance of patient-centredness in physiotherapy, and suggests that patients may be the best judges of the affective, non-technical aspects of a given healthcare episode.     

A model for using the VIPS framework for person-centred care for persons with dementia in nursing homes: a qualitative evaluative study

røsvik j., kirkevold m., engedal k., brooker d. & kirkevold ø . (2011) A model for using the VIPS framework for person‐centred care for persons with dementia in nursing homes: a qualitative evaluative study. International Journal of Older People Nursing 6 , 227–236 doi: 10.1111/j.1748‐3743.2011.00290.x Background. The ‘VIPS’ framework sums up the elements in Kitwood’s philosophy of person‐centred care (PCC) for persons with dementia as values, individualised approach, the perspective of the person living with dementia and social environment. There are six indicators for each element. Aim. To conduct an initial evaluation of a model aimed at facilitating the application of the VIPS framework. Design. Qualitative evaluative study. Methods. A model was trialled in a 9‐week pilot study in two nursing homes and evaluated in four focus groups using qualitative content analysis. Results. Five themes emerged: (1) Legitimacy of the model was secured when central roles were held by nurses representing the majority of the staff; (2) The model facilitated the staff’s use of their knowledge of PCC; (3) Support to the persons holding the internal facilitating roles in the model was needed; (4) The authority of the leading registered nurse in the ward was crucial to support the legitimacy of the model and (5) Form of organisation seemed to be of importance in how the model was experienced. Conclusion. The model worked best in wards organised with a leading registered nurse who could support an auxiliary nurse holding the facilitating function.     

Factors influencing home health care providers' performance of oral health care for older people: A qualitative study

Aim

To examine factors that affect the performance of oral health care (OHC) for older people receiving nursing care at home.

Background

Oral health is often neglected by health care providers caring for older people. Research shows that health care providers' provision of OHC may be influenced by various factors (barriers and facilitators). When this research was conducted, health care providers from home healthcare services (HHCS) and nursing homes were grouped together despite setting differences; therefore, this study focuses on the performance of OHC by home health care providers (HHCPs) as a single group.

Design

Explorative design with a qualitative approach.

Methods

The managers of four HHCS units recruited 17 HHCPs to participate in focus group interviews. One interview was conducted per unit, and there were four to five participants in each interview. The analysis of interviews was based on theoretical thematic analysis and the PRECEDE constructs in the PRECEDE–PROCEED model. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used in reporting this study.

Findings

The analysis resulted in two themes with predisposing factors (HHCPs' professional responsibilities, older people's attitude), five themes with enabling factors (knowledge and skills, older people/carer trust, available time, available equipment and collaboration with public dental service (PDS)), and two themes with reinforcing factors (routines and OHC focus on the workplace) that affect the provision of OHC. The factors were categorised as individual, organisational and collaboration factors.

Conclusions

In addition to individual factors found in previous studies, factors related to the organisation of services and communication between HHCPs and PDS seem to affect HHCPs' provision of OHC for adults receiving HHCS.

Implications for Practice

This study provides in-depth knowledge that can contribute to increasing HHCPs' provision of OHC and thereby prevent oral and dental disease among older people receiving HHCS.     

How people decide to seek health care: a qualitative study

BACKGROUND: There is considerable variation in service use, with overuse in conditions such as upper respiratory tract infections and high levels of unmet need in older patients with embarrassing conditions such as incontinence. The reasons for this situation are varied but to facilitate appropriate accessing of services the decision processes involved in help-seeking require greater understanding. OBJECTIVES: This study aimed to describe the decision making process for help-seeking in middle and older aged people with urinary storage symptoms. METHODS: In-depth qualitative interviews were carried out with 33 men and women who had sought medical care for urinary symptoms. Respondents were recruited from an epidemiological study of the prevalence of urinary symptoms in community dwelling adults aged 40 years and over. Questions were directed at help-seeking for urinary symptoms as well as help-seeking in general. Interviews were audio-taped and a thematic analysis carried out according to grounded theory methods. RESULTS: The steps in the decision process to seek medical care were drawn from the data. These consisted of appraisals of the presence and cause of symptoms, treatment options and the severity of symptoms and their impact on quality of life. Once the level of threat of the symptom was established, the costs and benefits of treatments and services were balanced against the perceived impact of symptoms on quality of life. These results were considered in relation to available models of health behaviour. CONCLUSIONS: Interventions that increase individuals' active involvement in their health care and which encourage greater knowledge of symptoms and outcomes will facilitate appropriate help-seeking and service use.