Psychosocial coping profiles after pain rehabilitation: associations with occupational performance and patient characteristics

Purpose The aims of the present study were to assess: (i) changes in coping by use of Multidimensional Pain Inventory profiles from baseline to follow-up, (ii) associations between Adaptive Coper (AC) profiles at follow-up and improvements in occupational performance (by Canadian Occupational Performance Measure COPM) and (iii) ability to predict AC profiles at follow-up by participants’ baseline characteristics. Method Data at baseline, discharge and follow-up from 525 participants in a pain rehabilitation program were analyzed with multivariate statistics. Results AC profiles increased and Dysfunctional (DYS) profiles decreased at follow-up. Clinically relevant improvements on COPM were associated with having an AC profile at follow-up. Being Nordic born, having longer education, an AC profile and higher baseline scores on satisfaction with performance predicted an AC profile at follow-up. Conclusions Pain rehabilitation seems to result in sustainable and favourable coping strategies at follow-up, and improved occupational performance is associated with favourable coping at follow-up. Outcomes need to be measured independently of improved coping strategies and improvements of participant’s individual goals such as difficulties to perform their most meaningful occupations. Patients at risk for unfavourable coping strategies may need modified interventions.

• Implications for Rehabilitation

• More participants reported a beneficial coping, MPI profile, in a long-term perspective after a pain rehabilitation program.

• Improvements on occupational performance prioritized as meaningful by each of the participants are related to adequate coping strategies at follow-up.

• The associations between improved occupational performance and beneficial coping profiles need to be better understood.

• Patients with worse initial occupational performance may need modified pain rehabilitation interventions to improve their coping strategies.

     

Resilience and coping strategies in cognitive behavioral group therapy for patients with panic disorder

BackgroundAlthough resilience and coping are important factors associated with mental health, they are rarely investigated in the treatment of patients with panic disorder (PD).ObjectiveTo evaluate the response to four resilience and coping strategy sessions added to the standard cognitive behavioral group therapy (CBGT) protocol for PD.DesignControlled clinical trial.MethodsThe control group (n = 50) attended 12 CBGT sessions, while the intervention group (n = 50) received four additional resilience and coping strategy sessions, i.e., 16 in total. Symptom severity, resilience, coping strategies, and quality of life were assessed at baseline and post-CBGT.ResultsSymptom severity and maladaptive coping strategies decreased significantly in both groups. However, the intervention group had increased resilience and improvement in the environment domain of quality of life.ConclusionsAdditional sessions have potential benefits for coping skills and resilience in PD patients, but these benefits should be evaluated in further long-term studies.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: A randomized controlled trial

ABSTRACT

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients’ adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants’ satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants’ clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence.     

A structural equation model on the attributes of a skills enhancement program affecting clinical competence of pre-graduate nursing students

BackgroundClinical competence remains an issue in nursing and has received greater emphasis than academic competence. Although skill enhancement programs are recommended and beneficial, there is limited evidence on its influence on the clinical competence of pre-graduate nursing students.ObjectiveThis study explored the attributes of a skills enhancement program that affect the perceived clinical competence of pre-graduate nursing students.Design and SettingA cross-sectional study was conducted in a private higher education institution in the Philippines from April to May 2016.Participant and MethodsA total of 245 pre-graduate nursing students participated and completed a three-part survey composed of the respondent's robotfoto, the Skills Enhancement Program Questionnaire, and the Clinical Competence Questionnaire. Factor analysis explicated the attributes of the skills enhancement program while structural equation modeling and path analysis analyzed the variables' relationship.ResultsFindings showed that a skills enhancement program has 4 attributes: supportive clinical instructor, comprehensive orientation, formative goals and objectives, and conducive learning environment. Although all attributes of the program positively affected clinical competence, a supportive clinical instructor had the strongest influence on all clinical competency dimensions.ConclusionA skills enhancement program that has a supportive clinical instructor, comprehensive orientation, formative goals and objectives, and conducive learning environment facilitates clinical competency development among pre-graduate nursing students. This knowledge provides momentum for nursing educators to review and refine their skills and the existing design of their skills enhancement program to further develop clinical competency among pre-graduate nursing students.     

Qualitative evidence for Resilience,Stress, and Ethnicity (RiSE): A program to address race-based stress among Black women at risk for cardiovascular disease

ObjectiveGrowing evidence demonstrates that perceived discrimination and racism are significant contributing factors to psychological distress, low-grade chronic inflammation, and cardiovascular health disparities among minorities, particularly among Black women. Despite this evidence, there are no evidence-based complementary therapy interventions available to ameliorate chronic stress associated with racism and discrimination. The purpose of this study was to examine the feasibility and effectiveness of a novel, 8-week, group-based stress reduction program, Resilience, Stress and Ethnicity (RiSE), designed to help Black women at risk for cardiovascular disease (CVD) develop effective coping skills for dealing with chronic stress uniquely associated with being a minority.MethodsWe conducted two semi-structured focus groups with Black women (N = 22) following their participation in the 8-week RiSE program. We analyzed the data using constant comparative qualitative methods.ResultsAttrition rate was low (13%) with all participants attending at least 6 of the 8 classes. Participants reported high levels of satisfaction with the program and the majority (81%) reported practicing the skills that they learned in real-life stressful situations. In describing the participants’ response to the program, four key categories emerged from the data: (1) Increasing awareness of stressors associated with perceived discrimination and racism; (2) Coping with race-based stressors; (3) Coping with other sources of stress; and (4) Increasing sense of empowerment and emotion regulation.ConclusionsFindings suggest that RiSE is feasible and effective in helping Black women at risk for CVD cope with chronic stress associated with being a minority. Given evidence that perceived discrimination and racism are underlying factors in many inflammatory-based chronic diseases, this research may have broader implications for reducing health disparities across a wide-spectrum of chronic illnesses in which women minorities are disproportionately affected.     

The EPICS Family Bundle and its effects on stress and coping of families of critically Ill trauma patients

AimThe aim of this study was to evaluate impact of the EPICS Family Bundle on stress and coping.BackgroundCritical care nurses frequently deal with family stress, but may be without knowledge and skills needed to assist families to cope.MethodsA non-equivalent control group design was used, with a convenience sample of 84 family members of critically ill patients. During the control phase, participants completed tools measuring stress and coping. The intervention included use of the EPICS Family Bundle. After implementation, participants completed the same tools as those administered during the control phase. Outcomes were analyzed using independent-sample t-tests.ResultsThe experimental group had a significantly higher coping score on two subscales; and although not statistically significant, it was also improved on an additional four.ConclusionAfter implementation of the intervention, families experienced improved coping. The study may have lacked sufficient power to detect all differences.     

Understanding coping strategies among people living with scleroderma: a focus group study

Abstract

Purpose: Systemic sclerosis or scleroderma is a chronic, rare connective tissue disease with negative physical and psychological implications. Coping strategies used by scleroderma patients have not been studied in-depth. The objective of the present study was to gain a greater understanding of the coping strategies employed by people living with scleroderma.

Method: Three semi-structured focus group discussions were conducted with a total of 22 people with scleroderma. Interviews were recorded, transcribed, and analyzed using content analysis. Coping strategies discussed were analyzed through Lazarus and Folkman’s theoretical model of coping, including: (1) problem-focused, (2) emotion-focused, and (3) meaning-focused coping.

Results: Participants reported using a combination of problem-focused (e.g., professional help; seeking disease-related information), emotion-focused (e.g., social support; adaptive distraction techniques), and meaning-focused coping strategies (e.g., benefit finding; goal reappraisal) to help them to cope with and manage their disease. However, many patients reported having difficulty in accessing support services.

Conclusions: Scleroderma patients use similar coping strategies as patients with more common diseases, but they may not have access to the same level of support services. Accessible interventions, including self-management programs, aimed at improving problem- and emotion-focused coping are needed. Further, increased access to support groups may provide patients with opportunities to obtain social support and enhance coping.     

Effects of a multifaceted neurological assessment educational program in nursing students: A randomized crossover study

AimThis study aimed to verify the effects of a multifaceted neurological assessment educational program on neurological assessment-related knowledge, skills, communication ability and self-efficacy in nursing students.BackgroundNurses should be equipped with optimal neurological assessment competency to ensure quality care for patients with neurological symptoms.DesignThis study involved a waitlist control group with a randomized crossover design.MethodsFourth-year nursing students were randomly assigned to an intervention group (n = 28) or a waitlist control group (n = 27). Pre- and post-intervention differences in neurological assessment knowledge, skills, communication ability and self-efficacy between the intervention and the waitlist control group were analyzed using generalized estimated equations.ResultsThe nursing students in the intervention group showed significantly improved knowledge, skills, communication ability and self-efficacy scores compared with those in the waitlist control group. Scores related to knowledge, skills and communication ability were maintained and self-efficacy scores had further increased at 2 weeks after the educational program in the intervention group.ConclusionsOur multifaceted neurological assessment educational program is useful for improving nursing students' knowledge, skills, communication ability and self-efficacy.     

Understanding autism spectrum disorder and coping mechanism by parents: An explorative study

ObjectiveThis study aimed to explore the perceptions of parents of children with autism spectrum disorder (ASD) and their coping strategies.MethodsThe data of the study was collected using face-to-face semi-structured interviews. The participants were purposefully selected from the three schools in Mpumalanga Province because they had children diagnosed with ASD and data was analyzed using thematic content analysis. In this study, primary caregivers were selected. In the end, 12 women were interviewed, and the data saturation was reached. Ethical considerations and measures to ensure trustworthiness were carried out throughout the study.ResultsThe findings revealed two themes: caregivers’ understanding and misconceptions of ASD and coping mechanisms used in dealing challenges of caring for a child with ASD; and five subthemes: lack of knowledge, cultural beliefs, prayer, strong support system, and acceptance.ConclusionBased on the findings, more awareness campaigns should be done on ASD to increase parents’ understanding of the condition. Understanding the cultural beliefs of parents regarding ASD may assist health care professionals in developing care practices that are accepted in their culture, and may enhance parents’ coping skills.     

Graduate Reflective Practice Program: Were Long-term Objectives Achieved?

BackgroundReflection has been identified as a deep learning strategy necessary for radiation therapists to foster professional growth, to monitor current practice, and to evaluate the effects of change. To further develop reflective practice in radiation therapists, a department-based reflective practice program was designed and implemented in 2010. The program continues to be delivered annually to each new cohort of graduates. Long-term objectives of the program included the continued use of reflective practice and participation in reflective activities; the ability to communicate knowledge, skills, and values through reflective discussion within the team environment; the further development of clinical knowledge and skills; and the promotion of a reflective culture within the department.AimThe purpose of the research was to establish if the learning program was meeting its long-term objectives. Are these radiation therapists continuing to use the reflective skills they developed during their graduate year?MethodAn online survey was designed to evaluate whether the long-term objectives of the program were being achieved. The target respondents were radiation therapists who had completed their graduate year in 2010 or 2011.ResultsSeven of a possible 10 radiation therapists completed the survey. All respondents perceived they are using reflection in their practice and results indicate that a number of reflective activities are actually being used. The majority of respondents indicated they had initiated reflective practice discussions in their work areas, and the overall perception indicated more frequent intentional reflective practice occurring within the department.ConclusionsThe evaluation of survey responses revealed that radiation therapists who participated in the reflective learning program during their graduate year continued using reflection skills and contributed to reflective activities within the clinical environment.     

Features of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital

BackgroundMedical Emergency Teams (METs) involve specialist staff who respond to acutely deteriorating ward patients. There is little literature describing the scope of practice and training of MET responders.PurposeTo describe and discuss an education and training program for Intensive Care Unit (ICU) nurses who function in a high capability teaching hospital MET.FindingsThe program is overseen and coordinated by four senior nurses. Applicants require at least three years experience working as an ICU nurse in a level 3 tertiary ICU. Each program participant is allocated a mentor and must complete the program within six months. Induction involves attending lectures outlining expected roles, responsibilities and appropriate conduct during MET calls. A course handbook outlines a series of competencies including checking of the MET trolley, assisting endo-tracheal intubation, commencement of non-invasive ventilation and high flow oxygen. Each participant attends the first five MET calls under supervision. A series of case scenarios are discussed and reviewed and an oral examination on two such cases is undertaken prior to completion of the program. Throughout, candidates are trained in their expected roles and responsibilities during MET calls, follow-up of at-risk and deteriorating patients, emergency calls in the mental health precinct, and assisting with procedures outside of the ICU. Emphasis is placed on both technical and non-technical skills.ConclusionsWe have provided a framework for the development of a MET nurse training program. The applicability of this program to other settings and effects of this program on patient outcomes remain unknown.     

Training in basic computer skills for academic physicians: The certificate of added qualification approach

Background: In the course of an academic fellowship program, many of the physicians participating expressed the need for computer skills training.

Purpose: The purpose of the tutorial program was to promote the effective and efficient learning of academic computer skills within the context of a busy fellowship program.

Methods: A series of self‐instructional tutorials was developed, including competency tests and practice tasks. Physician fellows participated in the voluntary computer skills tutorial program. Topics included system software, word processing, and graphics. Competency testing led to a “Certificate of Added Qualification,”; (CAQ) in computer skills.

Results: Eleven of 20 (55%) physician fellows completed all CAQ requirements during their fellowship program. The results of a follow‐up questionnaire indicated that 95% of the CAQ participants reported using computers at least several times per week.

Conclusion: By focusing on the tasks computer novices immediately need to perform, and keeping the instruction “lean,”; one can help academic medicine faculty acquire computer skills in an effective and efficient manner.     

Effectiveness of a strength-oriented psychoeducation on caregiving competence,problem-solving abilities,psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial

BackgroundFamily caregivers provide the foundation for long-term home care of stroke survivors. The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external resources to cope with this situation, thereby placing their own health at risk. We conducted a randomised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers.ObjectivesTo evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence, problem-solving coping abilities, caregiver’s depressive symptoms, caregiving burden and resources (family functioning, social support) and physical health (such as caregiving-related injury), as well as potential placement of stroke survivors.DesignA prospective multi-centre and single-blinded randomised controlled trial stratified by survivors’ history of stroke.Setting and participantsAdult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong.MethodsThe design of the trial was based on the relational/problem-solving model. Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of questionnaires before randomisation, immediately, one- and three-months post-intervention. The control group received usual care, whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme (two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions). Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests.ResultsWe recruited 128 caregiver–survivor dyads. The intervention group demonstrated significantly greater improvements throughout the study (p < 0.01) in terms of caregiving competence, problem-solving coping abilities and social support satisfaction. This group also displayed significantly greater improvements in terms of family functioning (p < 0.05) at one-month post-intervention, an increased number of social support (p < 0.001) and a lower level of burden at three-month post-intervention. However, there was no significant effect on enabling stroke survivors to remain in their home. Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities, which suggested its mediating effect on caregiving competence of stroke caregivers.ConclusionsFindings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors.     

The investigation of care burden and coping style in caregivers of spinal cord injury patients

PurposeThe level of care burden experienced by caregivers of patients with spinal cord injury and their coping style were evaluated in order to identify ways to improve their capacity to respond and reduce the care burden.MethodsA convenience sampling method was used to select 150 spinal cord injury patients who were discharged from the Second and the Third Affiliated Hospital of Nanchang University and their primary caregivers. The Chinese version of the Zarit Caregiver Burden Interview and the Simplified Coping Style Questionnaire were distributed to assess caregiver burden and coping strategies.ResultsThe care burden score of the caregivers of patients with spinal cord injury was 52.91 ± 11.56 points. Eighty-eight percent of caregivers reported moderate or severe care burden levels. The largest proportion of caregivers were female spouses, who were less likely to use an active coping strategy. A negative coping strategy was more frequently used by caregivers compared to healthy adults, and was positively correlated with burden of care. In contrast, a negative correlation was found between the care burden and an active coping style.ConclusionPrimary caregivers of spinal cord injury patients report a heavy burden of care. As active coping strategies are more beneficial, medical care providers should encourage caregivers to make more use of these coping styles to promote physical and mental health for themselves, their patients and their family, as well as to improve the quality of care provided.     

Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial

Abstract

Purpose: This randomized trial compared 6- and 12-month outcomes of a home-based psychoeducational program to mailed information provided to 159 survivors of stroke (SS) and their spousal caregivers (CG). Methods: SS (age 50+) and CG were recruited as dyads post-discharge from inpatient rehabilitation. All dyads received mailed information for 12 months. Dyads randomized to the home-based group received an average of 36.7?h of psychoeducation over 6 months. Health status, depression, stress, burden, coping, support, mutuality and function were obtained on all dyads. Repeated measures analysis with linear mixed models was used to compare the groups for change over time in the outcome variables. Results: Both groups demonstrated less depression and stress over time. Compared to the mailed information group, SS in the home-based group demonstrated significantly improved self-reported health and cognitive function; CG demonstrated significantly improved self-reported health and coping strategies. Mutuality and social support decreased in both groups. Conclusions: The home-based intervention was effective in improving self-reported health, coping skills in CG and cognitive functioning in SS. However, the finding that dyads in both groups demonstrated decreased depression and stress suggests that providing repeated doses of relevant, personalized information by mail may result in positive changes.

• Implications for Rehabilitation

• A stroke affects both the stroke survivor and the spousal caregiver, so nurses and therapists should use multicomponent strategies to provide education, support, counseling and linkages to community resources to ease the transition from hospital to home.

• Stroke may have a negative impact on the dyad’s relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge. Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling, as needed.

• Establishing an ongoing relationship with stroke survivors and their spouses and providing relevant and engaging information by mail can reduce stress and depression over 12 months post-discharge at a minimal cost.

• Nurses and therapists should consider home visits post-discharge to reinforce education and skills taught in the hospital, increase self-reported health in stroke survivors and spousal CG, increase coping skills and to link the couple to community resources.