The politics of interprofessional training—lessons from learning disability

The emphasis of this paper, while taking learning disability as a case study, is upon the challenges facing all professional bodies in the 1990s. Although very much a paper in its own right, this is also a development of some of the arguments made by Mathias & Thompson (1992). It is argued that analysts of joint training have largely failed to examine the changing political context which has fuelled interprofessional developments. This paper aims to fill that gap and illustrate how an analysis of developments in learning disability can provide lessons for other areas of health and social care. The conclusion is that interprofessional training may be essential to the survival of professional spheres of influence and practice.     

Patient or consumer? The colonization of the psychiatric clinic

Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.     

The slow death of psychiatric nursing: what next?

Nursing has always struggled for recognition and status, and there has always been exploitation and shortages, and no more so than in psychiatric settings. Today, however, nursing is in truly dire straits and, as a consequence, psychiatric nursing is more precariously positioned than ever. In order to think constructively about psychiatric nursing's future, it is crucial that this wider context in which it operates is fully appreciated, and this paper begins by summarizing the key features of this context from an international perspective. It is argued that dramatic changes occurring in 'Western' societies call for radical changes in public and professional thinking, and in their vision for health care in the future. Beginning with the general nursing context, this paper depicts the perilous state of psychiatric nursing and mental health care in Australia and elsewhere, and suggests some of the causal factors. It concludes by arguing that the future mental health workforce should be a graduate specialist who stands outside existing disciplinary identities.     

“They don’t understand that we also exist”: South African participants in competitive disability sport and the politics of identity

Purpose: To describe how athletes with disabilities talk about their experiences of participating in competitive disability sport in South Africa.

Method: In-depth semi-structured interviews were conducted with 20 athletes with disabilities. Data were analysed via thematic content analysis using an inductive data driven process.

Results: Participants described their involvement in competitive sport as a positive experience; they described it as a catalyst for the recasting of identities and reframing an understanding of physical impairment, a context for empowerment and resistance of disablist attitudes, and an arena in which a sense of inclusion and belonging is experienced. However, their narratives also lay bare something of the struggle on the part of persons with disabilities to be seen as fully human and reveal how participants reproduce some unhelpful disablist discourses.

Conclusions: There are complex contradictions and cross-currents in the way athletes with disabilities describe their participation in competitive disability sport. These narratives highlight political and ideological tensions about inclusion and representation and remind us of the need to document the experiences of persons with disabilities and the potential dangers inherent in idealizing disability sport.

• Implications for Rehabilitation

• Competitive sport is a useful context for rehabilitation and the empowerment of persons with disabilities.

• Athletes with disabilities say that they are able to resist dominant stereotypes about disability and recast their identities through participation in competitive sport.

• Disability sport seems to provide a setting in which persons with disabilities can reproduce unhelpful disablist discourses.

• There are dangers inherent in idealizing competitive disability sport.

• Even where athletes with disabilities are competing at the highest level and are successful, rehabilitation professionals must be aware of these issues, must be able to listen for experiences of exclusion and low self-esteem, and to engage with athletes on these issues.

     

The dual diagnosis facility: a renewed engagement with the psychiatry of intellectual disability?

A case study of a pilot residential facility for intellectually disabled adults who also suffer the effects of mental illness I presented in the context of the emergent debate surrounding the issue of dual diagnosis and co-morbidity. The innovative role of nurses in the establishment if this new service is discussed in terms of the beginning of a renewed engagement with the psychiatry of intellectual disability and it's implications for nursing practice and practice arrangements.     

The die has been cast? Rediscovering the essence of psychiatric nursing

Examination of the international literature that focuses on the historical 'developments' in psychiatric nursing shows a 'back and forth' shift in emphasis from interpersonal/therapy-based models to a concentration on pathophysiology, pharmacology and biological causation. Within this context, a number of ontological questions appear with conspicuous regularity and these are worthwhile considerations as they are tied to the very nature of psychiatric nursing. Examination of the relevant literature reflects this historical duality and indicates the existence of (at least) two versions of psychiatric nurse, each with a distinct emphasis. Given this documented duality, it is the duty of each nurse to ask themselves: What type of psychiatric nurse am I? What type do I want to be and what type would I want participating in the care of someone I love? Consequently, this article draws on bodies of literature pertaining to the extent of mental health problems, the views of mental health service users, and the different types of psychiatric nurse, in order to assist nurses in considering these questions. In the light of the clear emphasis evident within contemporary mental health policy and psychiatric nursing curricula, the article concludes that it may not be possible to reconcile the activities associated with both types of psychiatric nurse.     

A Review of: “The Past in the Present”

Older women report more loneliness than male peers. Loneliness is an area of concern related to the well being of older women because it is a cause of emotional distress and is linked to a variety of health problems in older individuals. Life changes, including widowhood and relocation, are associated with increased vulnerability to loneliness. Gender, social, and cultural factors influence the experience of loneliness in older women. Cognitive and interactionist theoretical approaches to loneliness have utility for nursing practice and research with older women who experience loneliness.     

Burden of treatment in the light of the international classification of functioning,disability and health: a “best fit” framework synthesis

Purpose: This systematic literature review aimed to (1) summarize and explain the concept of Burden of Treatment (BoT) using the International Classification of Functioning, Disability and Health (ICF) terminology, and (2) inform the development of a future Comprehensive ICF Core Set for BoT.

Method: Searches on EMbase, Medline, CINAHL and PsycINFO were conducted. Only qualitative studies were considered for inclusion. The screening and data extraction stages were followed by a “Best-fit” framework synthesis and content analysis, using the established ICF linking rules. Screening, data extraction, quality appraisal and data analysis were performed by two independent researchers.

Results: Seventeen studies were included in this review. The “Best–fit” framework synthesis generated 179 subthemes which identified that BoT impacts negatively on body functions and structures, restricts valued activities and participation and influences contextual factors through life roles, self-identify and relationships. The identified subthemes were linked to 77 ICF categories.

Conclusions: This study is part of the preparatory phase of a Comprehensive ICF Core Set for BoT and our findings will inform the further needed studies on this phase. The use of ICF terminology to describe BoT provides an accessible route for understanding this complex concept, which is pivotal for rethinking clinical practice.

• Implications for rehabilitation

• Health professionals applying the ICF should consider the negative impact of interventions on patient’s life roles and self-identity, body functions and structures and on valued activities and participation.

• Health professionals who may be concerned about the treatment burden being experienced by their patients can now use the ICF terminology to discuss this with the multidisciplinary team.

• Poor adherence to rehabilitation programs may be explained by an increased BoT. This phenomenon can now be mapped to the ICF, and coded using a framework well known by multidisciplinary teams.

     

Validation of the Hungarian version of the Roland–Morris disability questionnaire

Abstract

Purpose: To create a cross-culturally adapted and clinically valid Hungarian version of the Roland–Morris Disability Questionnaire (RMQ). Methods: After the translation and cross-cultural adaptation process, a total of 133 patients were included into the quality measurement study. Validity and reliability domains of the Hungarian RMQ were tested following the COSMIN guideline. Differences between clinically different patient groups were measured. Correlations of the RMQ with the Oswestry Disability Index (ODI), the World Health Organization Quality of Life-BREF assessment (WHOQoL) and pain were also calculated. To assess the reliability dimension, internal consistency (Cronbach’s α) was determined and the test–retest method was used to calculate the interclass correlation coefficient (ICC), the standard error of measurement (SEM) and the minimal detectable change (MDC). Results: Patients indicated for surgery or having neurological deficit had significantly higher RMQ scores. RMQ strongly correlated with pain (r?=?0.61), ODI (r?=?0.81) and physical subscale of WHOQoL (r?=??0.7). Reliability of the Hungarian RMQ was expressed with a Cronbach’s α of 0.87, ICC of 0.91 (p?<?0.001) and SEM and MDC as 1.71 and 4.74 points, respectively. Conclusions: Translation and cross-cultural adaptation process of the RMQ into Hungarian language was successful resulting in a reliable and valid measurement tool with good psychometric properties.

• Implications for Rehabilitation

• Low back pain (LBP) related disability is a big health, social and economical problem in industrial countries.

• Correct evaluation of spine related disability can be performed using valid and reliable national versions of condition specific patient reported questionnaires such as the Roland–Morris Disability Questionnaire (RMQ).

• After the cross-cultural adaptation and validation of the Hungarian RMQ, it can be reliably used for the evaluation of LBP patients and for their follow-up during a rehabilitation process.

     

Representations of disability in the Canadian news media: a decade of change?

Abstract

Purpose: To assess stability and change in representations of disability and persons with disability in the Canadian news media between 1998 and 2008. Method: The study replicated research conducted in 1998 that assessed the representation of disability in the Canadian news media. Following the earlier study, three newspapers were selected (Globe and Mail, Toronto Star and Toronto Sun) and all articles from a three-month period in 1998 and 2008 were assessed for disability content. In total, 362 articles were found in the two time periods. These were coded for structure and content using a schema developed in the earlier research. Results: Between 1998 and 2008, there was a significant increase in the proportion of stories using “person first” language, and a significant increase in the proportion of “progressively” themed articles (e.g. dealing with barriers to participation, or disability awareness and inclusion). At the same time, there were significant differences between newspapers, with the Toronto Sun (a tabloid) maintaining a strong focus on “traditional” themes (e.g. special education, charitable provision). Conclusions: The differences in news media representations between 1998 and 2008 suggest a positive change in the way people with disabilities are represented, with greater attention to the complexity of their identity and their multiple social roles.

• Implications for Rehabilitation

• The participation of persons with disabilities in society continues to be limited by negative attitudes.

• Media reporting has a significant influence on public attitudes toward disability.

• In a content analysis of three Canadian newspapers, this study found several significant changes in the language and content of disability-related articles.

• Together, these changes provide some evidence of more favorable media representations of disability. Further research in rehabilitation is needed to understand how such changes may both reflect and facilitate ongoing efforts to enhance people with disabilties’ participation in social life.