Using Patients,’ Relatives’ And Clinicians’ Experiences To Improve Follow Up Services And Recovery After Critical Care: An Experience-Based Co-Design Study

Background Following an episode of critical illness, two thirds of critical care unit (CrCU) survivors experience significant problems with physical functioning, mental health, social issues and returning to work. There is limited understanding and evidence to guide how services can effectively support patients and families during a prolonged recovery. This study aimed to identify and prioritise service improvements for patients who have survived an episode of critical illness. Methodology and Methods Using Experience-based Co-design (EBCD) methodology this study explored the experiences of former CrCU patients, their family members and the staff who delivered CrCU follow up services at a large teaching hospital in the Northwest of England. Filmed interviews with 10 former CrCU patients and audio recorded interviews with 9 staff members were conducted and a 30 minute film of patients’ experiences was developed which illustrated the major touchpoints (key events and experiences) of the recovery journey. A patient feedback event was held for patients to rate the touchpoints and capture the emotions and keywords evoked by each touchpoint to identify the positive and negative experiences of the recovery journey. Following this, a joint patient and staff event for patients, families and staff, was held and the patient film was used to trigger emotive aspects of the patient recovery journey. This triggered collaborative discussion between patients, families and staff which focused on identifying priorities for service improvement. Findings Four priorities for service improvement were identified; improving the CrCU experience for patients; addressing patients’ emotional and psychological needs; positioning patients at the centre of services; and, developing a supportive framework to promote the recovery process. Contribution to current knowledge The EBCD methodology enabled the whole patient journey from critical illness through recovery to be captured. The focus on improving patient experiences and the development of collaborative partnerships between patients, families and staff has determined which elements matter most to patients during their recovery. Using this approach progressed care delivery, bringing what patients felt was important into the centre of service co-design and created the potential to improve outcomes

Dementia Praecox or the Group of Schizophrenias

"Our literature is replete with complaints about the chaotic state of the systematics of psychoses and every psychiatrist knows that it is impossible to come to any common understanding on the basis of the old diagnostic labels. ... Thus, not even the masters of science can make themselves understood on the basis of the old concepts and with many patients the number of diagnoses made equals the number of institutions they have been too. ... Errors are the greatest obstacles to the progress of science; to correct such errors is of more practical value than to achieve new knowledge. We have here eliminated chaos of terms behind which useful concepts of disease were mistakenly sought; we have eliminated a veritable forest of boundary posts, not one of which indicated any natural line of demarcation. ... By the term „dementia praecox“ or „schizophrenia“ we designate a group of psychoses whose course is at times chronic, at times marked by intermittent attacks, and which can stop or retrograde at any stage, but does not permit a full restitutio ad integrum. The disease is characterized by a specific type of alteration of thinking, feeling, and relation to the external world which appears nowhere else in this particular fashion." Eugen Bleuler. Dementia Praecox or the Group of Schizophrenias. Translated by Joseph Zinkin. International Universities Press, New York, 1950

Content and Psychology

The theoretical underpinnings and practical worth of content-based, intentional, or "folk" psychology have been challenged by three distinct groups of philosophical critics in the past 15 years or so. The first group, comprised by Hilary Putnam, Tyler Burge, and other advocates of "wide" or "externalist" theories of meaning, claims that traditional psychologists have been mistaken in assuming that our beliefs, desires, and other content-laden states supervene on or inhere in our individual minds or brains. The other two groups are both "eliminative materialists," who charge that the intentional approach is inadequate and that it can or will be replaced by a completely non-interpretive discipline: either neuropsychology, in the view of Patricia and Paul Churchland, or a strictly syntactic computational psychology, according to Stephen Stich. ;This dissertation defends "notional world" or narrow intentional psychology against these charges, primarily on the strength of its practical merits, in contrast to the limitations and adverse effects of the proposed alternatives. Psychology is at least partly an applied science with a mandate to help understand and treat concrete psychological problems such as Post Traumatic Stress Disorder and depression, I argue, so any theorist who proposes to reconfigure or phase out existing approaches must be prepared to take over these duties with at least equal facility. However, whereas various "narrow" schools of psychotherapy such as Cognitive Therapy are fairly successful in this regard and show every indication of continuing to be needed for the foreseeable future, the Syntactic Theory seems to show very poor promise of being able to help relieve the distress of people with psychological disturbances, while a purely neurobiological approach is inappropriate in many cases, and tends to cause a variety of untoward and dangerous side-effects. As for the "wide" theorists with their emphasis upon the social and environmental contributions to meaning: they must acknowledge that a good deal of content is in the head; and, more importantly, by focusing on the role of the "experts" in a society's language-game, they miss the whole point of a psychological attribution, which is to understand an individual's reasons--however idiosyncratic--for acting as he or she does

For Weariness Cannot but Fill our Men after so long a Period of Hardship and Endurance: War Weariness in the Canadian Corps in the First World War

My project explores war weariness in the First World War, especially regarding the Canadian Corps. The first section (legal, disciplinary, and medical systems) looks at the army policies, structures, and personnel in place to deal with morale, discipline, endurance, motivation, and medical problems. These structures served to \u27measure\u27 the problems facing individual soldiers and units, and attempted to address these issues before they became more widespread and intractable. Policies were also designed to mitigate emerging problems and to ensure that sufficient troops were in the line and able to perform their duties adequately. Unfortunately, these systems were often insufficient to deal with emerging problems, and thus the next section explores how these problems played out for the Corps in two periods: April-August 1917, and July-November 1918. These periods provide insight into the contributing factors to the onset, development, and negative consequences of individual and collective war weariness, as well as mitigating factors that helped offset it. These periods were also chosen to highlight the comparative nature of this project, whereby the Canadian experience was juxtaposed with other armies on the Western Front, as well as with Canadian forces over the course of the second half of the war. Other armies were suffering \u27wear and tear\u27 and indicating manifestations of incipient breakdown, but the Canadians were able to carry on without substantial reductions in fighting effectiveness or large-scale indiscipline. The reasons why the Corps was able to prevail despite the emerging and collective war weariness will be explored in this project

An attempt to minimize the adjustment reaction of aged home entrants in the Greater Cape Town area.

Bibliography: leaf 342-367.The literature indicates that admission to an aged home are produces a severe crisis for the aged newcomer. The symptoms resulting from this final move are an increase in affective disturbance (anxiety, depression, hostility and suspiciousness), cognitive disequilibrium (confusion, disorientation and mental disorganization) and social withdrawal (apathy). The present study was designed to assess the efficacy of two different treatment approaches in attenuating this stress. 90 elderly persons admitted into 9 aged homes, a cross-section taken from the Greater Cape Town area, were randomly assigned to one of three groups: (a) Crisis Intervention Group (C.I.) subjects were seen twice weekly for five consecutive weeks in an attempt to minimise the expected adjustment reaction. (b) Social Attachment and Activity Group (S.A.) subjects were seen once a week for the same time period to support the new resident through this difficult transition. (c) Control Group subjects received no treatment either previous or subsequent to location in the hone. Treatment conditions were compared using a within-subject and between-group pre-test post-test follow-up design. Biological, psychological and social levels of functioning were assessed with a battery of tests at three points: on admission to the hone, in the sixth week, and finally, in the third month of residency. Results clearly indicate that the C. I. treatment was the most effective. The nature of the C.I. approach lends itself to wide use by those who have had no specialized training in psychotherapy. This has important implications for the ready improvement of present conditions in residential institutions for the aged

The arts of care in an asylum and community 1925-2004: Kenmore Hospital, New South Wales and Canberra, the Australian Capital Territory

This thesis examines the arts of care in an asylum in New South Wales (NSW) and a mental health community in the Australian Capital Territory in twentieth-century Australia, and describes and compares a range of governmental responses for responding to persons deemed to be in need of care. The thesis explores similarities between twentieth-century Australian care techniques and the key principles underpinning a ‘care system’ that was developed over 200 years ago. It proposes three twentieth-century care regimes, each one characteristic of a certain period: Herd Care, set in an asylum era that emphasised custodialism and confinement (1925-1958); Therapeutic Community, a period during which the asylum was reconfigured into a facilitative community (1959-1983); and Community Care, beginning around 1983, when NSW asylums were ‘rationalised’, their care techniques fragmented and outsourced in diverse settings generally referred to collectively as the mental health community. Some of the dynamics, continuities and ruptures in twentieth-century care regimes are analysed. Chapters describe the landscapes of care. They explore how environmental settings have been designed to reinforce the care regimes in which they are mobilised and how they ‘make up’ the possibilities for action of the subject of care. The dynamics of care between care providers and their recipients are examined. Some of the continuities and discontinuities of meanings associated with ‘family’ and ‘community’ in each of the care regimes are observed. Fieldwork findings are combined with the cultural narrative of psychiatric primitivism to consider why subjects have been deemed in need of care, at times in need of protection and training and at other times in need of discipline and restraint. The new possibilities for action that have emerged in Australian twentieth-century mental health governance are considered, when subjects of care have been encouraged to learn how to be fre

Women and depression in interwar Britain : case notes, narratives and experiences

This research is an attempt to reconstruct the lived experiences of female patients who were deemed to suffer from depression in interwar Britain and explore the ways in which these sufferers understood and attributed their mental illness. In order to achieve these goals, this research analyses women’s own narratives embedded in medical records, notably case notes of the Maudsley Hospital and Holloway Sanatorium, and applies new concepts of life cycle and life event. What female patients experienced in the course of their mental illness, including the types and details of depressive symptoms, were largely decided by their social class, age and gender. They usually related the onset of depression to what they underwent in their daily lives, contrary to professional attributions which stressed heredity as a decisive aetiological factor. The case histories demonstrate that the patients were familiar with medical knowledge, not necessarily the latest ideas though, and that the lay understanding of health and ill-health affected considerably their experiences of mental depression. Moreover, the medical records inform us about women’s life in general and women’s sexuality: living as a woman in the interwar years meant that one had to cope with more traditional and conventional conditions rather than modern ones. This research also improves our understanding of British psychiatry in interwar years, as well as the status of depression as a medical concept. Contrary to the general claim that the Great War was the starting point of modern psychiatry, interwar years should be interpreted as a period of transition, when the influence of the nineteenth-century medical tradition was still strong. The modernisation of depression, which was to be completed only after the Second World War, owed much to the Victorian psychiatry, although it was authorised as a formal diagnosis and defeated its powerful predecessor, melancholia, during the interwar period

Hearing Voices, Demonic and Divine

The Open Access version of this book, available at www.taylorfrancis.com/books/9781472453983, has been made available under a Creative Commons Attribution-Non Commercial-No Derivative 4.0 license. Experiences of hearing the voice of God (or angels, demons, or other spiritual beings) have generally been understood either as religious experiences or else as a feature of mental illness. Some critics of traditional religious faith have dismissed the visions and voices attributed to biblical characters and saints as evidence of mental disorder. However, it is now known that many ordinary people, with no other evidence of mental disorder, also hear voices and that these voices not infrequently include spiritual or religious content. Psychological and interdisciplinary research has shed a revealing light on these experiences in recent years, so that we now know much more about the phenomenon of "hearing voices" than ever before. The present work considers biblical, historical, and scientific accounts of spiritual and mystical experiences of voice hearing in the Christian tradition in order to explore how some voices may be understood theologically as revelatory. It is proposed that in the incarnation, Christian faith finds both an understanding of what it is to be fully human (a theological anthropology), and God’s perfect self-disclosure (revelation). Within such an understanding, revelatory voices represent a key point of interpersonal encounter between human beings and God