Creative writing in recovery from severe mental illness

There is evidence that creative writing forms an important part of the recovery experience of people affected by severe mental illness. In this paper, we consider theoretical models that explain how creative writing might contribute to recovery, and we discuss the potential for creative writing in psychosocial rehabilitation. We argue that the rehabilitation benefits of creative writing might be optimized through focus on process and technique in writing, rather than content, and that consequently, the involvement of professional writers might be important. We describe a pilot workshop that deployed these principles and was well‐received by participants. Finally, we make recommendations regarding the role of creative writing in psychosocial rehabilitation for people recovering from severe mental illness and suggest that the development of an evidence base regarding the effectiveness of creative writing is a priority.     

Reflections on ... writing for successful publication

BACKGROUND: Most writers feel stuck at some point in the writing process. These reflections are based on what occupational therapists and others have learned from their own experiences about writing papers and publishing their work in peer-reviewed journals. METHOD: In 2004, I invited students and colleagues to send me their top three writing strategies to prepare for an interactive workshop on writing for publication. These writing strategies were later posted on a website and sent to everyone whom I had initially contacted. RESULTS: The writing strategies began with choosing the topic and moving the writing along through the submission process. They concluded with responding to feedback from reviewers and building one's writing skills. PRACTICE IMPLICATIONS: These reflections may provide other writers with ways to pursue their writing projects.     

An adaptation of item modeling for developing test‐item banks

An adaptation of item modeling, an item‐writing procedure, is described. As with related methods, the procedure includes dividing the stem of an item into discrete elements of information and then altering the elements to create new items. In this adaptation, writers were instructed to change the elements so that each incorrect option in the original item becomes the correct answer to a new item. Another part of the process, an innovation that increases the number of items generated, is to change the question asked of examinees (e.g., from diagnosis to treatment) for each item and write new response options.

Two novice item writers applied modeling to patient‐based, one‐best‐answer items. They found the procedure easy to use and intuitive. From 13 items, they produced 209 modeled items in 24 at‐home hours, plus 12 hr of meeting time. A consultant evaluated a subset of items and estimated that approximately half the items were of sufficient quality to appear on a subspecialty certifying examination. Though the project had several limitations, item modeling appears to have promise as an efficient item‐writing procedure. Conservative estimates suggest it is about four times more productive than a traditional committee‐based approach.     

Translation,adaptation and validation of instruments or scales for use in cross‐cultural health care research: a clear and user‐friendly guideline

Rationale, aims and objectives The diversity of the population worldwide suggests a great need for cross‐culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross‐cultural research and/or provide quality patient care. Although there are well‐established methodological approaches for translating, adapting and validating instruments or scales for use in cross‐cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross‐cultural validation of instruments and scales, and to propose and present a clear and user‐friendly guideline for the translation, adaptation and validation of instruments or scales for cross‐cultural health care research. Methods A review of highly recommended methodological approaches to translation, adaptation and cross‐cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven‐step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. Conclusions Translation, adaptation and validation of instruments or scales for cross‐cultural research is very time‐consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.     

Lived‐experience participation in nurse education: Reducing stigma and enhancing popularity

Mental health nursing consistently emerges as less popular than other specialties, and both service users and mental health practitioners are affected by negative attitudes. Education is fundamental to attracting students to the field of mental health nursing. The aim of this study was to determine the impact of undergraduate mental health curricula on student attitudes to people with mental illness, and career interest in mental health nursing. A traditional mental health course was compared to a course delivered by a person with lived experience of mental illness (and mental health service use) for its impact on student attitudes and career intentions in mental health nursing (cohort 1: n = 70, cohort 2: n = 131, respectively). In both cohorts, attitudes were measured via self‐report, before and after the course, and changes were investigated through within‐subjects t‐tests. The lived experience‐led course demonstrated statistically‐significant positive changes in intentions to pursue mental health nursing and a decrease in negative stereotypes, which were not observed in the traditional course. The valuable contribution of mental health nursing emerged in the traditional, but not lived‐experience‐led, programmes. These findings support the value of an academic with lived experience of mental health challenges in promoting attraction to mental health nursing as a career option.     

Engaging clinicians in motivational interviewing: Comparing online with face‐to‐face post‐training consolidation

Motivational interviewing (MI) is an evidence‐based intervention that has been widely recommended in clinical settings where consumer behaviour change is a goal of treatment. Training clinicians in MI, as with other translational endeavours, does not always result in changes to clinical practice. The present study compares two post‐training approaches to consolidate MI skills following a training workshop. We randomly assigned 63 clinicians working in mental health or drug and alcohol services to receive either face‐to‐face group consolidation sessions or to access a series of online consolidation resources. We compared clinician engagement and devised a new instrument to measure clinician outcomes. Participants who completed follow‐up consolidation retained knowledge, attitudes, and practices, regardless of consolidation method. Face‐to‐face consolidation sessions were superior to online materials in engaging participants (mean sessions attended was 2.1 (maximum possible = 3) compared to a mean of 1.38 sessions, respectively (t(61) = ?2.73, P = 0.008, d = 0.72, 95% confidence interval: 0.19–1.25). Engagement to the completion of consolidation sessions was also influenced by previous training in MI. For every additional hour of previous MI training, there was a 10% increase in the odds that the participant would complete the final consolidation session.     

Therapeutic relationships and involuntary treatment orders: Service users' interactions with health‐care professionals on the ward

There is increasing evidence that an involuntary hospital admission and treatment can undermine the therapeutic relationship. While good relationships with staff are important factors influencing long‐term recovery, there is little information on how people experience their relationships with staff while under an involuntary treatment order (ITO). Twenty‐five involuntary inpatients were interviewed about their experiences of an ITO. The interviews were analysed by a general inductive approach. Participants described the following themes: (i) the ITO admission was a daunting and frightening experience; (ii) staff behaviours and attitudes shaped their experiences in hospital; (iii) importance of staff listening to their concerns; (iv) importance of having a space to make sense of their experiences; (v) importance of staff ability to look beyond their illness and diagnosis; and (vi) importance of staff working in partnership. These findings highlight that when using recovery principles, such as an empathic engagement with the patients' lived experience, forging partnerships with patients in treatment decision‐making to enhance agency, an involuntary treatment order does not have to limit the ability to establish positive relationships.     

Art and health care: A dialog about interdisciplinary collaboration

Tell Well is an innovative creative writing and storytelling workshop developed by a public health nursing scholar and educator and a writer and educator. The demonstration project was a writing workshop designed especially for nurses. While the overall objective of Tell Well is to teach writing and storytelling as self‐care tools for health care workers to address professional quality of life, the interdisciplinary collaboration has proven to be a vital component of the program's development. After an exploration of the importance of bringing the arts and humanities to nurses and their nursing practice, the writer and the nurse engage in a dialog about the collaboration, its origins, the challenges faced, and the value of such interdisciplinary endeavors.     

The lived experience of the diabetes nurse specialist regular check-ups, as narrated by patients with type 2 diabetes

Aim. The aim was to elucidate the lived experience of regular diabetes nurse specialist check‐ups among patients with type 2 diabetes. Background. Diabetes care with diabetes nurse‐led clinics in primary care has been established in Sweden since the 1980s. Information about patients’ lived experience of these regular check‐ups is important in the further development of diabetes nursing in primary care. Methods. Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check‐ups by the diabetes nurse specialist. A phenomenological‐hermeneutic method inspired by Ricoeur was used in the analysis. Results. Patients’– with type 2 diabetes – lived experience of regular check‐ups showed an overall positive influence on the patients’ way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent‐independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control. Relevance to clinical practice. The development of diabetes‐nurse‐led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self‐management in terms of patients’ own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care.     

Repeated sleep‐quality assessment and use of sleep‐promoting interventions in ICU

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep‐promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep‐promoting interventions has not been widely reported. An observational study was conducted in a 58‐bed adult intensive care unit. Sleep quality was assessed using the Richards‐Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep‐promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open‐ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep‐promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards‐Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards‐Campbell Sleep Questionnaire was used on repeated occasions, and sleep‐promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards‐Campbell Sleep Questionnaire for the subjective self‐assessment of sleep quality in intensive care unit patients and the implementation of simple‐promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.     

Simplifying the writing process for the novice writer.

Nurses take responsibility for reading information to update their professional knowledge and to meet relicensure requirements. However, nurses are less enthusiastic about writing for professional publication. This article explores the reluctance of nurses to write, the reasons why writing for publication is important to the nursing profession, the importance of mentoring to potential writers, and basic information about simplifying the writing process for novice writers.     

The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke,during the first year postdischarge

BÄCKSTRÖM B, ASPLUND K and SUNDIN K . Nursing Inquiry 2010; 17 : 257–268
The meaning of middle‐aged female spouses’ lived experience of the relationship with a partner who has suffered a stroke, during the first year postdischarge Stroke consequences present a great long‐term challenge to the spouses of the stroke sufferer. A longitudinal study with a phenomenological hermeneutic approach was used to illuminate the meanings of middle‐aged female spouses’ lived experience of their relationship with a partner who has suffered a stroke, during the first year postdischarge. Four middle‐aged female spouses of stroke sufferers participated in the study. Narrative interviews were conducted 1, 6 and 12 month postdischarge (total of 12 interviews), audio‐taped and transcribed verbatim to a text and interpreted by a phenomenological hermeneutic method inspired by Ricoeur. The findings showed a process over time during which spouses come to know, recognize and acknowledge the residual changes in their partners’ cognitive and emotional conditions and the impact on their relationship. Spouses showed grief due to the loss of the marital relationship they once had and anxiety that they would not be able to continue in an undesired relationship in the future. Even if the partner is still alive, there is a loss to grieve and to be understood, an important meaning of the transition process in the relationship during the first year after the partner's discharge.     

Being in a standstill‐of‐life: women's experience of being diagnosed with systemic lupus erythematosus: a hermeneutic‐phenomenological study

Systemic lupus erythematosus (SLE ) is a highly unpredictable and potentially lethal disease which ultimately challenges identity, future and the meaning of life. In a caring context, the experience of good health is perceived to be a balance between biomedical health and the existential experience of having a good life. This balance is jeopardised in the face of severe chronic illness and leads to extensive suffering if not handled carefully. Research suggests that patients suffering from severe chronic illness need support on an existential level, but also emphasises that, given its elusive nature, caring for the existential dimension is difficult to manage. This paper explores the experience of being diagnosed with SLE as an existential phenomenon. Through repeated phenomenological and hermeneutic interviews with 15 women conducted from 2013 to 2015, data concerning the diagnostic phase of SLE were analysed using Van Manen's phenomenology of practice. The essence was found to be a standstill in life comprehended through three inter‐related themes: standing in a swirl of events, standing on uneven ground and standing at a turning point with oneself and others. The paper elucidates how existential life phenomena are lived, during the course of being diagnosed. In conclusion, it provides an ethical awareness of how a standstill in life is lived and of the patients’ existential transition during the diagnostic phase. A holistic approach is recommended in caring for patients with SLE .     

Performance‐based assessment during clinical placement: Cross‐sectional investigation of a training workshop for practice educators

Performance‐based assessment evaluates a health professional student's performance as they integrate their knowledge and skills into clinical practice. Performance‐based assessment grades, however, are reported to be highly variable due to the complexity of decision‐making in the clinical environment. The aim of this study was to evaluate the impact of a training workshop based on frame‐of‐reference principles on grading of student performance by physiotherapy practice educators. This was a prospective cross‐sectional study which used a single group pre‐test, post‐test design. Fifty‐three practice educators rated two video vignettes depicting a poor and very good student performance, using a subsection of a physiotherapy performance‐based assessment tool before and after training. Overall, results showed that participants amended their scores on approximately half of all scoring occasions following training, with the majority decreasing the scores awarded. This impacted positively on scoring for the poor performance video, bringing scores more in line with the true score. This study provides evidence of the benefit of a training workshop to influence decision‐making in performance‐based assessment as part of a wider education program for practice educators.     

Feasibility of a guideline to improve the match between needs and services for chronic addicts with multiple problems

In The Netherlands, a substantial part of the population of chronic hard drug users and alcoholics is reached by offering low‐threshold services addressing basic needs such as shelter, health care and methadone substitution. It is known, however, that the needs of this category of addicts are more differentiated than can be demonstrated in the context of these low‐threshold services. Therefore, a guideline to help target‐group analyses was developed for addiction care agencies, resulting in so‐called “client profiles”. First, the workability of the guideline was tested in the restructuring of methadone programs in two regions of The Netherlands. Second, we investigated to what extent the resulting client profiles offer the addiction care agencies relevant and sufficient information for the development of tailor‐made care. A process evaluation supported the application of the guideline. The results show that the guideline is feasible, but could be improved by more simplified instructions and by adding a step‐by‐step plan. The resulting client profiles proved to be relevant and informative for the process of developing tailor‐made care for chronic addicts.