Patient experiences of uncertainty - a synthesis to guide nursing practice and research

hansen b.s., rørtveit k., leiknes i., morken i., testad i., joa i. & severinsson e. (2012) Journal of Nursing Management 20, 266–277
Patient experiences of uncertainty – a synthesis to guide nursing practice and research Aim The aim of this study was to provide a synthesis of patients’ experiences of uncertainty in illness and the interventions outlined, based on qualitative research. Background There is a need to explore various patient experiences from a nursing perspective in order to achieve evidence-based practice and improve the quality of care. Uncertainty in illness is a dynamic experience – a stressor with a major impact on patients’ illnesses. Methods A literature search performed on PubMed and Cinahl yielded 15 qualitative studies that met the inclusion criteria and which were analysed and interpreted. Results Experienced uncertainty was one of two main areas comprising three themes: explaining, feeling and facing uncertainty. The second main area was suggested intervention strategies consisting of three themes: organizing the patient trajectory throughout the health-care system, supporting patients through relationships and providing knowledge through clear and accurate communication. Conclusion Providing insight, confidence and supporting the patients’ feeling of control are of importance for health-care professionals. Implications for nursing management Structured organization of the trajectory system should be followed up, while outcome measures (patient satisfaction), education and training programmes for patients and families after discharge to improve coping strategies and reduce uncertainty should be developed. Nurse leaders should work towards the establishment of clinical academic nursing positions to integrate knowledge, skills, experiences and research into everyday routines.     

A comparison of adolescent- and adult-onset first-episode, non-affective psychosis: 2-year follow-up

This study aimed to compare 2-year outcome among individuals with early-onset (EO; <18?years) versus adult-onset (AO) first-episode, non-affective psychosis. We compared clinical and treatment characteristics of 43 EO and 189 AO patients 2 years after their inclusion in a clinical epidemiologic population-based cohort study of first-episode psychosis. Outcome variables included symptom severity, remission status, drug abuse, treatment utilization, cognition and social functioning. At baseline, EO patients were more symptomatically compromised. However, these initial baseline differences were no longer significant at the 2-year follow-up. This study challenges the findings of a larger and older literature base consisting primarily of non-comparative studies concluding that teenage onset indicates a poor outcome. Our results indicate that adolescent-onset and adult-onset psychosis have similar prognostic trajectories, although both may predict a qualitatively different course from childhood-onset psychosis.     

Identification of ostruthin from Peucedanum ostruthium rhizomes as an inhibitor of vascular smooth muscle cell proliferation

Inhibition of vascular smooth muscle cell (VSMC) proliferation is of substantial interest in combating cardiovascular disease. A dichloromethane extract from the rhizomes of Peucedanum ostruthium, a traditionally used Austrian medicinal plant with anti-inflammatory properties, was examined for a putative antiproliferative activity in rat aortic VSMC. This extract inhibited serum (10%)-induced VSMC proliferation concentration dependently. Further identification and biological testing of its major constituents revealed that the coumarin ostruthin (7) is the major antiproliferative substance. In summary, a new bioactivity of P. ostruthium rhizomes is described, and 7 has been identified as the responsible compound.     

Neurocognition and occupational functioning in patients with first-episode psychosis: a 2-year follow-up study

Neurocognitive deficits are a core feature of schizophrenia that is associated with poor occupational functioning. Few studies have investigated this relationship in patients with first-episode psychosis. The current study examined the characteristics of employed and unemployed patients with first-episode psychosis at baseline and 2-year follow-up, and the predictive value of neurocognition on employment status. One-hundred and twenty-two first-episode psychosis patients were assessed with clinical and neurocognitive measures at baseline. Occupational status was assessed at baseline and 2-year follow-up. Those unemployed at baseline were rated lower on global functioning and were more likely to have a schizophrenia spectrum disorder. Total employment rates were 41% at baseline and 38% at 2-year follow-up. Four employment paths emerged at follow-up, defined as persistently employed, becoming unemployed, entering employment and persistently unemployed. The persistently employed group had the highest global functioning score. For the total sample, baseline employment status and sustained attention predicted employment status at follow-up. For those employed at baseline, better sustained attention, higher global functioning, more positive symptoms and less alcohol use predicted persistent employment at follow-up. For those unemployed at baseline, none of the variables predicted change in employment status. Implications of these results are discussed.     

Are multi family groups appropriate for patients with first episode psychosis? A 5‐year naturalistic follow‐up study

Rossberg JI, Johannessen JO, Klungsoyr O, Opjordsmoen S, Evensen J, Fjell A, Haahr U, Joa I, Langeveld J, Larsen TK, Melle I, Rund BR, Simonsen E, ten Velden W, Vaglum P, Friis S, McGlashan T. Are multi family groups appropriate for patients with first episode psychosis? A 5‐year naturalistic follow‐up study. Objective: To compare outcome over 5 years for patients who participated in multi family groups (MFGs) to those who refused or were not offered participation. Method: Of 301 first episode psychotic patients aged 15–65 years, 147 participated in MFGs. Outcome was measured by drop‐out rates, positive and negative syndrome scale (PANSS) symptom scores, and duration of psychotic episodes during the follow‐up period. Results: Multi family group participants had a significantly lower drop‐out rates at 5‐year follow‐up than patients who did not participate. However, the MFG participants had significantly less improvement in PANSS positive and excitative symptoms and had significantly longer duration of psychotic symptoms during the follow‐up period. Conclusion: Multi family groups appear to increase the chance of retaining patients in a follow‐up study, but adjustment of the programme may be necessary with first episode psychosis patients to meet their needs better.     

Differences in legal outcomes for male and female children who have been sexually abused

The goal of the present study was to determine whether or not there were sex differences in legal outcomes for children who were sexually abused. Using the methodology of Joa and Edelson (2004), the results indicated that males who were sexually abused had poorer legal outcomes than females. Specifically, it was found that cases involving male victims were less likely to be filed with the District Attorney (DA) than cases involving female victims and had fewer criminal counts charged. For those children seen at a Child Abuse Assessment Center, cases involving female victims were significantly more likely to be filed by the DA's office than were cases involving male victims. Finally, there were differences in whether guilty defendants pled guilty or were found guilty at trial depending on whether the defendant sexually abused a male or female. The implications of the findings are discussed.