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1.
Objective
Lack of knowledge and powerlessness make family restrains, chains or confines (pasung) the family member with mental illness. This study aimed to explore the experience of adolescents having mentally ill parents with pasung.Method
To achieve detailed and accurate understandings of adolescents’ experiences, this study used a qualitative research design with a phenomenological approach. Purposive sampling was employed to find teenagers aged 12-19 years old who had mentally ill parents with pasung. The data were analyzed with Colaizzi's method.Results
Parents with mental illness, specifically with physical restrain and confinement (pasung) had psychosocial impact on adolescents. Role changes often occur in the family where teenagers should be a breadwinner and caregiver for their parents. The results of this study were described in three themes: 1) changes of life due to have mentally ill parents with pasung; 2) reciprocity as the reason for taking care of the parents; 3) positive meaning of living with mentally ill parents with pasung.Conclusions
This study concludes that psychosocial treatment for adolescents living with parents with pasung should consider the psychological and social impact as a result of taking care of their parents with pasung. 相似文献2.
Susan Oehler Ashleigh Berman Cecilia Gay Rose Manguso Jessica Espinoza 《Archives of Psychiatric Nursing》2018,32(1):39-43
PURPOSE
This study aimed to examine the relationship between behavioral variables and aggression among severely and chronically mentally ill inpatients in a Social Learning Program (SLP) at a state psychiatric facility.METHODS
Using archival data over a 24-month period, a total of 23 severely and chronically mentally ill inpatients comprised the sample in this study. The predictor variables included length of current hospitalization; length of stay on SLP; basic activities of daily living (ADLs); instrumental ADLs; attendance in programming; participation in programming; and the number of minor, major, and intolerable infractions received. The criterion variable was number of aggressive episodes (e.g., hitting persons or objects).RESULTS
Results of a standard multiple regression analysis indicated an overall model of two predictors (intolerable infractions and instrumental ADLs) that significantly predicted number of aggressive episodes. Findings suggested that SLP patients who have a tendency to be aggressive are able to adequately and concurrently complete daily hygiene needs and participate in scheduled treatment groups and activities.DISCUSSION
Our findings provide valuable information regarding aggressive tendencies that can inform treatment planning. Specifically, our results suggested there are not necessarily obvious warning signs for aggression among severely and persistently mentally ill inpatients. Rather, other individualized patient factors may be at play in the expression of aggressive impulses, emphasizing the importance of adequate staff-to-patient ratios so that care planning and implementation can be appropriately individualized. 相似文献3.
Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff
Kelly Graziani Giacchero Vedana Danielle Maria da Silva Carla Aparecida Arena Ventura Bianca Cristina Ciccone Giacon Ana Carolina Guidorizzi Zanetti Adriana Inocenti Miasso Tatiana Longo Borges 《Archives of Psychiatric Nursing》2018,32(3):367-372
Background
Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated.AimIn this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units.Method
Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism.Results
Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior.Conclusions
This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients. 相似文献4.
Background
Despite the strong influence of culture on family involvement in disease management, few studies have examined how immigrant families care for persons with mental illness. The purpose of this study was to examine how immigrant families organize their world to care for a mentally ill person in the United States. The current analysis focused on how Confucian notions of filial piety and parental obligation shape caregiving in Korean immigrant families.Methods
Participants in this interpretive phenomenological study were comprised of six Korean immigrant women caring for a family member with mental illness. Participants provided narratives that illustrate challenges and opportunities in caring for their mentally ill family member.Results
Three family caregiving patterns were discerned. Insulating from the outside world describes a family’s effort to accept a member's illness and to manage it within the family. Prioritizing education over well-being concerns parental commitment to the Confucian priority of educating one’s children. Reciprocating the sacrifice describes how a family adapts and enacts filial piety.Conclusion
The findings of this study warrant further study to examine the influence of Confucianism among Korean American families. The three patterns of caregiving are strongly aligned with Confucian notion of family and family engagement. These patterns may help health providers to anticipate the needs of and provide individualized, culturally appropriate mental health care for patients with mental illness and their families of Korean origin.5.
Objective
Patients with violent behavior can harm themselves, others and environment. It can be an indicator for mental health hospital admission. Violent behaviors can be characterized by verbal and physical attacks demonstrated by the individuals intensively. Management of violent behaviors in hospital often uses restraint, but it has physical and psychological effects. This study aimed to explore experience of restraint use among patients with violent behaviors in mental health hospital.Method
To gain deep understanding related to the patients' experiences, this study used a qualitative design with a phenomenological approach. Purposive sampling was employed to find patients who were restrained during their hospitalization. The number of participants in this study was 8 participants. The data were analyzed with Colaizzi's method.Results
Patients with violent behavior, specifically with physical restraint during their hospital-ization had negative impacts on patients. The results of this study were described in three themes: 1) aggressive behavior as one of the main reason of restraint; 2) professional healthcare supports during the restraint use, and 3) physical and psychosocial impact of the restraint use.Conclusions
The impact of restraint is related to human right violations and ethical dilemma. The process of decision-making for employing restraint, especially in relation to violent behavior management, requires a consideration of the rights of the patient. Every individual has the right of self-determination, liberty, security and physical integrity. 相似文献6.
Loretto Quinney Trudy Dwyer Ysanne Chapman 《Collegian (Royal College of Nursing, Australia)》2018,25(3):263-269
Background
The incidence of chronic illness is growing globally and nurses within the family circle often fulfil a caring role for relatives who are chronically ill. Registered nurses who are also carers have a unique vantage point to evaluate healthcare provision.Aim
This study aimed to develop insights into healthcare provision from understanding the lived experience of participants who were family carer and professional nurse.Methods
This paper is drawn from a larger phenomenological study that explored the lived experience of fifteen registered nurses who cared for family who had a chronic illness. Unstructured interviews of one hour duration were used as the method of data collection to enable thematic analysis of the findings within the context of Heideggerian philosophy.Findings
The research identified that participants held three distinctive ways of being a nurse and family carer while at the bedside of their chronically ill family member. During the critical times of exacerbation and hospitalisation, the carer who is also a nurse, has professional and personal insights which enable them to; navigate healthcare systems to access care, progress through hospital safely and build pathways towards discharge.Discussion and conclusion
In contrast to much of the previous literature, which has focused upon the needs of nurses who are family carers, this paper focuses upon the contributions that participants can make to the nursing profession and the wider health industry. Understanding the contribution that carers can make to patient safety and improved health outcomes may bring focus and purpose to the implementation of care for the chronically ill. Participants developed insights into healthcare provision from repeated exposure through multiple admissions and this repository of knowledge may have previously been overlooked. 相似文献7.
Catherine E. Mosher Rebecca N. Adams Paul R. Helft Bert H. O’Neil Safi Shahda Nicholas A. Rattray Victoria L. Champion 《Supportive care in cancer》2016,24(5):2017-2024
Purpose
Family caregivers of advanced colorectal cancer patients may be at increased risk for psychological distress. Yet their key challenges in coping with the patient’s illness are not well understood. Soliciting both patient and caregiver perspectives on these challenges would broaden our understanding of the caregiving experience. Thus, the purpose of this research was to identify caregivers’ key challenges in coping with their family member’s advanced colorectal cancer from the perspective of patients and caregivers.Methods
Individual, semi-structured qualitative interviews were conducted with 23 advanced colorectal cancer patients and 23 primary family caregivers. Interview data were analyzed via thematic analysis.Results
In nearly all cases, patient and caregiver reports of the caregiver’s key challenge were discrepant. Across patient and caregiver reports, caregivers’ key challenges included processing emotions surrounding the patient’s initial diagnosis or recurrence and addressing the patient’s practical and emotional needs. Other challenges included coping with continual uncertainty regarding the patient’s potential functional decline and prognosis and observing the patient suffer from various physical symptoms.Conclusions
Findings suggest that eliciting the perspectives of both patients and caregivers regarding caregivers’ challenges provides a more comprehensive understanding of their experience. Results also point to the need to assist caregivers with the emotional and practical aspects of caregiving.8.
Nickolas Speeney Kirstyn Marie Kameg Thomas Cline Janene Luther Szpak Brea Bagwell 《Archives of Psychiatric Nursing》2018,32(6):845-849
Background
Undergraduate nursing students may not have the opportunity to assess and intervene with a patient diagnosed with schizophrenia during their clinical rotation. Provision of a standardized patient simulation experience affords students this opportunity in a safe setting without risk to the patient or student.Methods
A quasi-experimental design was utilized to explore the impact of the addition of a standardized patient simulation scenario depicting a patient with a diagnosis of schizophrenia on undergraduate nursing student knowledge and perceived competency.Results
The mean values for perceived competence and knowledge increased significantly over the three time periods (p?<?0.001).Conclusion
The results suggest that incorporating SP simulation into the undergraduate psychiatric mental health nursing course has the potential to enhance both knowledge and perceived competency of students in caring for patients diagnosed with schizophrenia and ultimately promote better healthcare outcomes. 相似文献9.
The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study
Background
Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care.Objective
To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients.Methods
A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison.Setting
An 18 bedded tertiary intensive care unit in New Zealand.Participants
Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40 kg/m2.Findings
Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient’s body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients.Conclusions
Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care. 相似文献10.
Background
Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs).Purpose
The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training.Methods
Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature.Findings
EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research.Discussion
Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs. 相似文献11.
Jorge Hugo Villafa?e Kristin Valdes Virginia O&#x;Brien Monica Seves Raquel Cantero-Téllez Pedro Berjano 《Journal of bodywork and movement therapies》2018,22(1):37-39
Objective
The purpose of this study was to elucidate expert opinion on the conservative treatment of thumb carpometacarpal (CMC) joint osteoarthritis (OA).Methods
A 21-item survey to determine the practice patterns of Italian hand therapists who treat arthritis of the CMC joint was developed and distributed through a professional online survey service to assure confidentiality and anonymity.Results
Of the respondents, 80.8% were physical therapists; the remaining 19.2% were occupational therapists. 84.6% of the specialists who make decisions regarding patient pain management education.Conclusions
There is variability in the knowledge and practice patterns of Italian hand therapists relating to conservative management of thumb CMC OA. 相似文献12.
Background
In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear.Aim of this study
Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation.Methods
A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation.Results
Approximately 40?% of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5?% were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21?% of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80?% of the patients voted for pain control in the palliative setting.Conclusion
The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.13.
Lisa M. Klein Daniel Young Du Feng Annette Lavezza Stephanie Hiser Kelly N. Daley Erik H. Hoyer 《Nursing outlook》2018,66(3):254-262
Background
Hospital-acquired functional decline due to decreased mobility has negative impacts on patient outcomes. Current nurse-directed mobility programs lack a standardized approach to set achievable mobility goals.Purpose
We aimed to describe implementation and outcomes from a nurse-directed patient mobility program.Method
The quality improvement mobility program on the project unit was compared to a similar control unit providing usual care. The Johns Hopkins Mobility Goal Calculator was created to guide a daily patient mobility goal based on the level of mobility impairment.Findings
On the project unit, patient mobility increased from 5.2 to 5.8 on the Johns Hopkins Highest Level of Mobility score, mobility goal attainment went from 54.2% to 64.2%, and patients exceeding the goal went from 23.3% to 33.5%. All results were significantly higher than the control unit.Discussion
An individualized, nurse-directed, patient mobility program using daily mobility goals is a successful strategy to improve daily patient mobility in the hospital. 相似文献14.
Elizabeth Dzeng Daniel Dohan J. Randall Curtis Thomas J. Smith Alessandra Colaianni Christine S. Ritchie 《Journal of pain and symptom management》2018,55(2):282-289.e1
Context
The American Medical System is programmed to a default setting of aggressive care for the terminally ill. Institutional norms of decision making have been shown to promote high-intensity care, regardless of consistency with patient preferences. There are myriad factors at a system, clinician, surrogate, and patient level that drive the culture of overly aggressive treatments in American hospitals.Objective
The objective of this study was to understand physician perspective of the ways systems-level factors influence patient, physician, and surrogate perceptions and consequent behavior.Methods
Semi-structured in-depth qualitative interviews with 42 internal medicine physicians across three American academic medical centers were conducted. This qualitative study was exploratory in nature, intended to enhance conceptual understanding of underlying phenomena that drive physician attitudes and behavior.Results
The interviews revealed many factors that contributed to overly aggressive treatments at the end of life. Systemic factors, which describe underlying cultures (including institutional, professional, or community-based cultures), typical practices of care, or systemic defaults that drive patterns of care, manifested its influence both directly and through its impact on patient, surrogate, and physician behaviors and attitudes.Conclusion
Institutional cultures, social norms, and systemic defaults influence both normative beliefs regarding standards of care and treatments plans that may not benefit seriously ill patients. 相似文献15.
Sheila A. Boamah Heather K. Spence Laschinger Carol Wong Sean Clarke 《Nursing outlook》2018,66(2):180-189
Background
Improving patient safety within health care organizations requires effective leadership at all levels.Purpose
The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes.Methods
A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling.Finding
The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events.Conclusion
The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses. 相似文献16.
John S. Garrett Colyn Berry Hao Wong Huanying Qin Jeffery A. Kline 《The American journal of emergency medicine》2018,36(9):1581-1584
Background
To address emergency department overcrowding operational research seeks to identify efficient processes to optimize flow of patients through the emergency department. Vertical flow refers to the concept of utilizing and assigning patients virtual beds rather than to an actual physical space within the emergency department to care of low acuity patients. The aim of this study is to evaluate the impact of vertical flow upon emergency department efficiency and patient satisfaction.Methods
Prospective pre/post-interventional cohort study of all intend-to-treat patients presenting to the emergency department during a two-year period before and after the implementation of a vertical flow model.Results
In total 222,713 patient visits were included in the analysis with 107,217 patients presenting within the pre-intervention and 115,496 in the post-intervention groups. The results of the regression analysis demonstrate an improvement in throughput across the entire ED patient population, decreasing door to departure time by 17?min (95% CI 15–18) despite an increase in patient volume. No statistically significant difference in patient satisfaction scores were found between the pre- and post-intervention.Conclusions
Initiation of a vertical split flow model was associated with improved ED efficiency. 相似文献17.
Introduction
The suicide rate in Guyana was five times higher than the world average in 2014 (WHO) which puts Guyana at the top of the list with 44.2 per 100,000 people, the highest suicide rate in the world. For every completed suicide, there are survivors who experience high levels of psychological, physical, and social distress, and report feelings of guilt, shame, social stigma, and search for meaning.Aim
The aim of this qualitative study was to explore how family members coped and understand the suicide of their loved one, and to determine what resources were available to help them during this transition.Method
Ten family members were recruited to participate in a focus group. The focus group lasted approximately 90?min and was recorded. The audio recordings were later transcribed.Results
Four overarching themes emerged from the data: (1) perceived causes of suicide, (2) perceived solutions, (3) barriers to helping persons who are suicidal, and (4) personal and community reactions to suicide.Implications for practice
Nurses in Guyana are uniquely positioned to take a leadership role in creating and implementing postvention programs for suicide survivors that are culturally and ethnically relevant. Opportunities to partner with schools of nursing in higher income countries are explored. 相似文献18.
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Lisa J. Sundean E. Carol Polifroni Kathryn Libal Jacqueline M. McGrath 《Nursing outlook》2018,66(3):222-232