Perceptions of Barriers and Benefits to Physical Activity Among Outpatients in Psychiatric Rehabilitation

PURPOSE: To explore perceived barriers and benefits to physical activity in people with serious and persistent mental illness (SPMI) who were enrolled in community-based psychiatric rehabilitation. DESIGN AND METHODS: Four focus groups, two for men and two for women, were held with a total of 34 outpatients from two program sites. The investigators used a semistructured interview guide to facilitate the discussions. Audiotapes of the discussions were transcribed and analyzed for concepts and themes. FINDINGS: Significant barriers to physical activity were: mental illness symptoms, medications, weight gain from medications, fear of discrimination, and safety concerns. Being in a psychiatric rehabilitation program offered comfort and belonging, but it also had the effect of leaving activity initiation up to the program staff, which some participants perceived was part of required program compliance. However, participants viewed physical activity positively, and they linked being active to improved mental health. CONCLUSIONS: Outpatients in psychiatric rehabilitation valued physical activity, but mental illness symptoms, medication sedation, weight gain, fear of unsafe conditions, fear of discrimination, and interpretations of program compliance were barriers. Confronting how attitudes and barriers specific to this population can affect activity and reframing program compliance to include the independent initiation of activity as part of improving health might help clients of mental health services to become more active.     

Access to specialist palliative care services by people with severe and persistent mental illness: A retrospective cohort study

Compared to the general population, people with pre‐existing serious and persistent mental illness (SPMI) have higher rates of physical illness and die at an earlier age, raising questions about their palliative and end‐of‐life care needs when they are diagnosed with an incurable physical illness. In the present study, we explored access to specialist palliative care services within one New Zealand health district. Routinely‐collected, de‐identified patient information on a cohort of people diagnosed with SPMI, and receiving specialist palliative care services from the Capital and Coast District Health Board (CCDHB), was compared to the general population from the same health district. People with SPMI are 3.5 times less likely to receive specialist palliative services compared to the general population from the Capital and Coast District Health Board. The proportion of people identifying as Māori is 1.2 times higher in the SPMI cohort than the general CCDHB population. The SPMI cohort experiences a higher level of deprivation compared to the general population in the CCDHB. The present study confirms that those diagnosed with an SPMI are less likely to use specialist palliative care services at the end of life. Research using a national dataset is needed to determine whether the study findings are applicable to the national population.     

An online approach to providing chronic illness self-management information

The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.     

Management of chronic illness: voices of rural women

BACKGROUND: The prevalence and cost of chronic illness globally and in the United States of America continue to escalate and the day-to-day management of these conditions presents a major challenge. The burden of chronic illness disproportionately affects vulnerable populations such as women and those living in rural areas. AIM: To add to the knowledge base of illness management by chronically ill rural women through examining their individual perceptions of the illness experience. METHOD: The Women to Women project provided a nursing research-based computer intervention model for conducting support groups, providing health education, and fostering self-care, via personal computers and evaluated its effect on the women's psychosocial health. FINDINGS: Fatigue and pain were the major physical symptoms that impacted the women's quality of life, with depression and stress being the primary emotions they experienced. The characteristics of humour, hope, and courage were key in their successful adaptation to living with chronic illness. CONCLUSIONS: The women's voices relate how they manage their illness responses and adaptation mechanisms. The data provide nurses with information to heighten their sensitivity to clients' day-to-day needs and experiences. It will assist them in their designing and planning of interventions that will enable clients to adapt and to have the best quality of life possible within the limitations of their chronic illnesses. The data are also important to nurses involved in rural research and theory development concerning self-management and adaptation to chronic illnesses.     

Issues of women dually diagnosed with HIV infection and substance use problems in the Carolinas

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have unique needs that require integration of physical and psychosocial interventions. These women may benefit from the services of psychiatric or mental health nurse practitioners who have the skills necessary to address the many psychosocial issues women face as well as provide physical treatment. Additionally, drug treatment services need to be expanded and made more comprehensive. Drug treatment programs need to be developed specifically for women, and these services need to be made accessible to poor women with substance abuse problems. Further, drug treatment programs need to provide comprehensive services that can appropriately integrate the treatment of HIV disease and substance abuse.     

ISSUES OF WOMEN DUALLY DIAGNOSED WITH HIV INFECTION AND SUBSTANCE USE PROBLEMS IN THE CAROLINAS

A growing number of women are being dually diagnosed with HIV infection and substance use problems. Forty-two percent of all women diagnosed with AIDS have been infected through injection drug use. Many more women with HIV are exposed to nonintravenous drugs that potentially affect their quality of life and illness experience. This study sought to identify from the perspective of women factors that most influenced their ability to obtain treatment for their HIV infection and control their substance use. A focus group approach was used for data collection. Twenty-five HIV-infected women participated in one of four focus groups. Women were asked to identify and discuss their concerns and needs related to HIV/AIDS and substance use. Twenty-four women were African-American; one was white. All the women reside in South Carolina or North Carolina. Each focus group session was audiotaped and transcribed. Content analysis, following Krippendorff's (1980) methodology, was used to analyze the data. Five themes emerged: 1) AIDS as a life-altering event; 2) spirituality; 3) mental health issues; 4) barriers to health care services; and 5) environmental influences. It was concluded that the coexistence of HIV and substance abuse adds to the complexity of women's treatment needs. For these women, an HIV diagnosis can serve to alter their lives either positively or negatively. Dually diagnosed women have needs that require integration of physical and interventions. These women may benefit from services of psychiatric or mental health nurse who have the skills necessary to address the psychosocial issues women face as well as provide treatment. Additionally, drug treatment services to be expanded and made more comprehensive. Drug programs need to be developed specifically for and these services need to be made accessible to women with substance abuse problems. Further, drug programs need to provide comprehensive services can appropriately integrate the treatment of HIV and substance abuse.     

Group therapy for survivors of childhood sexual abuse who are severely and persistently mentally ill

Background: Few researchers have investigated the effectiveness of long-term group psychotherapy with women who have a core issue of childhood sexual abuse, particularly those who are designated as being severely and persistently mentally ill (SPMI). Women so labeled are usually treated within a biological framework. Medications and supportive care are often the preferred therapies, denying the necessity of dealing with past traumatic issues.Objectives: The objective of this pilot study was to determine the outcome of long-term, time-limited group therapy with women designated as SPMI. The study addressed rate of improvement in symptomatology and self-esteem scores in women who are SPMI and those not designated SPMI.Study Design: A quasi-experimental design was used. The sample (N = 72) consisted of women older than 18 years who were sexually abused as children. The experimental group was made up of women labeled SPMI (n = 13), and the control group was composed of those who had not been designated SPMI (n = 59). The intervention consisted of 50 weeks of group therapy using a family systems model. The instruments, which included the Beck Depression Inventory, the Symptom Check List-90-Revised, and the Rosenberg Self-Esteem Scale, were administered at sessions 1 and 50.Results: Results indicated that women labeled SPMI had lower self-esteem and higher symptomatology scores before receiving the group therapy, but both groups achieved comparable improvement in scores at the end of 50 weeks of group therapy.Conclusion: The results indicated that women labeled as SPMI could benefit from group therapy that addressed the core issue of childhood sexual trauma.     

Mental health nurses' attitudes towards severe perinatal mental illness

Title.  Mental health nurses' attitudes towards severe perinatal mental illness.
Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.
Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.
Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.
Findings.  Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.
Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.     

Health promotion information: sources and significance for those with serious and persistent mental illness

For 19 sources of health promotion information 41 adult outpatients with severe and persistent mental illness (SPMI) indicated by questionnaire how much information they received from each source and their opinion of its reliability. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists provided the most health promotion information and were regarded as the most reliable sources. Nurses and pharmacist were seen as providing more, and media and print sources as providing less, information than in similar studies of nonmentally ill samples. Nonpsychiatrist physicians, psychiatrists, nurses and pharmacists are significant sources of health promotion information for persons with SPMI--perhaps even more so than for those with no mental illness.     

Primary Health Care of Elderly Women

Traditional health care of the expanding elderly population has focused on illness diagnosis and management. However, because more individuals, women especially, are living longer and living better, the emphasis should be shifted and modified to include primary health care for elderly people. Primary health care includes active health promotion and health maintenance, prevention of illness or disability, and attention to the quality as much as to the quantity of life. Unfortunately, the health concerns of elderly women, especially the oldest-old groups who live more or less independently, have been addressed inadequately in medical and nursing literature. Routine approaches to health care for women aged 70 and older must consider women's apparent hardiness, potential social isolation, and unique worries about safety and independence. Nurse practitioners in adult health, family practice, and gerontology must expand their repertoire of health promotion and health maintenance strategies to meet the needs of this special population. This article outlines the role of the nurse practitioner in the care of the well elderly woman.     

Meeting health care needs of a vulnerable population: perceived barriers

This study utilized the qualitative methodology of focus groups to explore health care needs and perceived barriers to obtaining health care for urban and rural women and children in areas served by nurse practitioner (NP) and certified nurse midwife (CNM) clinics. The clinics operate in a southeastern county with a rural health professional shortage area designation, and an urban ZIP code area with high rates of infant mortality and serious pediatric conditions. The aim of the study was to delineate barriers to health care in order to develop appropriate services at the clinics and to improve access. Four focus groups with a total of 31 women from the communities were convened. Content analysis shows that access to the clinics is hampered by the community women's limited knowledge of CNMs and NPs and their specific roles in providing health care services. The women suggested that clinics counter their low profile by a more vigorous outreach promotion.     

Barriers to Family Care in Psychiatric Settings

PURPOSE: To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care. DESIGN AND METHODS: A qualitative exploratory approach with focus groups. Seventy-eight people participated in 11 focus groups conducted with families, patients, and health professionals. FINDINGS: Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system-based barriers, professional practice-based barriers, and family-based barriers to care. Patients stated the need for their families to be better educated about mental illness. CONCLUSIONS: The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.     

Engaging Persons with Severe Persistent Mental Illness into Primary Care

Persons with severe and persistent mental illness (SPMI) consistently experience inadequate primary health care. Very little is known about what promotes primary care (PC) engagement by persons with SPMI. That gap was addressed by a recently published qualitative study that described the social process of engagement in PC from the perspective of those with SPMI. This article describes the clinical implications of the findings from the qualitative study. Categories of engagement are described, and clinical practice implications based on these categories aim to promote engagement in PC with this population.     

Constructions of sexuality for midlife women living with chronic illness

AIM: In this paper, we reveal constructions of sexuality that were articulated by women who participated in an inquiry which aimed to understand the experiences of midlife women who live with chronic illness. The aim of this paper is to illuminate sexuality as an important health issue for women living with chronic illness and to offer ways that nurses may acknowledge and facilitate sexuality issues for women. BACKGROUND: The first author, as part of her doctoral study, corresponded with 81 women living with chronic illness. The participatory inquiry was framed by feminist principles and enabled women to anonymously share their experiences and collaborate in the direction of the research. During the analysis phase of the research, it became evident that illness had altered the way in which women conceptualized sexuality. DESIGN: The three authors performed secondary analysis of the original data set in order to re-examine the impact that chronic illness had on the sexuality of midlife women who live with chronic illness. Whilst we acknowledge that sexuality has multiple meanings, in this paper we describe the way in which women themselves have constructed and articulated their sexuality. FINDINGS: We found that sexuality incorporated women's desires, appearance, sexual feelings and expression and imposed on aspects of their lives that they had not needed to acknowledge before illness intruded. Three concerns are discussed; the changing body, meeting the needs of others and communicating sexuality. CONCLUSIONS: This paper reveals that issues of sexuality are an important health concern for women who live with long-term illness and should be acknowledged in sensitive and responsive health practices. The paper concludes that it is important for nurses to provide women opportunity for open and genuine communications about sexuality. In this way, a foundation of acceptance for the whole person is established which provides women permission to ask questions and seek assistance with sexuality issues.     

Metabolic diseases and associated complications: sex and gender matter!

Background  Clinicians and health professionals are increasingly challenged to understand and consider the different health needs of women and men. The increase of gender awareness and the expanding science of gender medicine will affect more and more clinical practice. This review addresses gender-specific aspects in metabolic disorders and related complications, which represent an increasing burden of this century and a great challenge to public health.
Design  There is increasing evidence of gender-related differences in risk factors, clinical manifestation and sequelae of obesity and diabetes and increasing knowledge that prevention, detection and therapy of illness affect men and women differently.
Results  Some gender-specific aspects, especially regarding cardiovascular disease, have been studied in more detail, but for many complications sex-related analyses of the results of both clinical trials and basic science are still missing or disregarded. Impaired glucose and lipid metabolism as well as dysregulation of energy balance and body fat distribution have a great impact on overall health via neuroendocrine changes and inflammatory pathways and deteriorate the course of many diseases with particular harm for women. Metabolic diseases dramatically affect life of men and women from infancy up to old age and are a major challenge for women during pregnancy. Great impact is attached to the intrauterine period and the lifelong implications of fetal programming.
Conclusions  Initiation of prospective studies on the impact of gender as primary outcome and investigation of gender-related pathophysiological mechanisms of chronic diseases will help to improve patient care and to implement evidence-based gender-specific prevention programs and clinical recommendations in future.     

A case of health disparity: treatment issues in women with hepatitis C.

Although the incidence of hepatitis C virus (HCV) in women is only slightly less than in men, women are poorly represented in research trials. As a result, not much is known about them as a subgroup. The specific aims of this article were to report on the problem, study methods, and findings focusing on HCV-positive women's health beliefs, how they identify and understand their health and illness states, and their explanatory models of illness behavior. A pilot study using three focus groups was conducted with women in the community, in recovery, and incarcerated. Two groups emerged: those with and those without access to knowledge and HCV services. Latinas emerged as a prominent subgroup. Women in all three groups wanted more information and to stay clean, were worried about contagion, and stated that they were secretive and ashamed of their disease. Due to the small study design, this study should be repeated with a larger sample and in a wider geographic area. The results suggest that immediate interventions for this health disparity are needed, including dissemination of this information to primary and specialty care providers and the legislature.     

Computer-based support groups. Nursing in cyberspace

The focus of this article is on the nurse monitor role in a project whose overall goal is to use telecommunication technology to provide information and support to middle-aged rural women living with chronic illness. The impact of participation in these support groups on the women's psychosocial health is also discussed. The purpose of the project, the underlying conceptual framework of social support, a project overview, project philosophy and protocols, and the role of the Nurse Monitor are described.     

An evaluation of an online intervention to provide social support and health education

Managing chronic illness in the isolation of rural environments is challenging for women who lack access to personal sources of social support and health information. The Women to Women project was designed to provide chronically ill rural women access to support and health information via electronic means. This article reports on the acquisition of computer skills, the perceptions of importance of various aspects of the intervention, and an assessment of women's overall satisfaction with participation in the research project. Findings indicate that the women's self-ratings of computer skills improved significantly over the 22-week intervention and that highly interactive features of the project were rated as most important by the participants. Overall, women found the program beneficial in assisting them to better manage their chronic illness.