Rasprava o “problematičnom pacijentu” ne pridonosi oporavku Talking about “the problematic patient” does not benefit recovery

The norm in therapy and treatment is that patients should follow instructions and show compliance in order to achieve the desired outcome. However, outcomes are not always achievable in those cases when patients do not comply with the care instructions and therefore are called noncompliant patients (Jin, Sklar, Min Sen Oh, Chuen, 2008)

Latent or Manifest Observers: Two Dichotomous Approaches of Surveillance in Mental Health Nursing

Background. Surveillance is a central activity among mental health nursing, but it is also questioned for its therapeutic value and considered to be custodial. Aim. The aim of this study was to describe how mental health nurses use different approaches to observe patients in relation to the practice of surveillance in psychiatric nursing care. Methods. In this study, Spradley's twelve-step ethnographic method was used. Results. Mental health nurses use their cultural knowing to observe patients in psychiatric care in various ways. Two dichotomous approaches were identified: the latent and the manifest approach. Discussion. Different strategies and techniques for observing patients are structured along two dichotomies. The underlying relationships between these two different dichotomous positions transform the act of observing into surveillance. This is further developed in a theoretical model called the powerful scheme of observation and surveillance (PSOS)

Začiniti svoj život – virtualna komunikacija o iskustvima upotrebe sintetičkih kanabinoida

Uvod: Znanstveni dokazi o uporabi sintetičkih kanabinoidima i njihovim štetnim fiziološkiim i psihološkim učincima u znatnom su porastu i to zbog povećanog broja provedenih/publiciranih laboratorijskih i kliničkih istraživanja. Međutim, nedostatan je opseg opisa osobnih iskustava korisnika tijekom konzumiranja opijata. Stoga se u članku opisuju unutarnja/osobna i opisana iskustva korisnika [engl. insider perspective]. Svrha: cilj je istražiti i opisati publicirane anegdote u komunikaciji tijekom konzumiranja sintetskih kanabinoida među korisnicima. Metode: netnografička metodologija primijenjena na temelju podataka iz rasprava objavljenih na forumu [internet]. Rezultati: Rezultati su prikazani u dvije kategorije: 1.) razmjena komunikacijskih iskustava s naglaskom na stanje opijenosti i 2.) razmjena komunikacijskih stavova, normi i vrijednosti korisnika. Analiza utvrđuje da među konzumentimasintetskih kanabinoida koji su objavili poruke postoji gotovo jednoglasan stav u vezi s negativnim iskustvima te verificiraju da uporabu treba izbjegavati. Zaključak: performativnost interaktivnosti može biti važan čimbenik u pomaganju korisnicima koji su uplašeni u razjašnjavanju njihovih iskustava. Dakle, platforma za komunikaciju među korisnicima sintetskih kanabinoida ima važnu unutarnju [engl. insider perspective] vrijednost

Retenção e isolamento retratados através de imagens publicadas no Twitter: quais são as implicações para os profissionais de saúde?

Objective: To map areas of discusión about use of seclusion and restraint in healthcare, as expressed in motifs posted on Twitter. Materials and method: We adopted a qualitative approach with an archival and cross-sectional observational design. 188 images from Twitter postings were analyzed. Results: Five categories were identified: Informative and educational messages; Equipment as artifacts; Spatiality; The restrained subjects; Sociopolitical connotations of restraint. Conclusions: Based on our results we conclude that restraint- and seclusion images posted on Twitter included several aspects; the intention to educate others, show the spatiality in relation to restraint, imagining characterized by objects and persons, and a sociopolitical connotation. This in turn means that Twitter posts offer nurses a chance to engage in social marketing and connoting an ethical dimension to a person associated with measures used to exert power over others. This is because communication surrounding certain controversial issues in healthcare is free from hierarchies on Twitter.Objetivo: Determinar las áreas de discusión sobre la aplicación del aislamiento y restricción en el campo de la salud, teniendo como base los motivos publicados en Twitter. Materiales y métodos: En la investigación se aplicó un enfoque cualitativo basado en un diseño observacional transversal y de archivo. Se analizaron 188 imágenes publicadas en Twitter. Resultados: Se identificaron cinco categorías: mensajes informativos y educativos; los equipos como artefactos; espacialidad; los sujetos a los que se le aplica restricción y connotaciones sociopolíticas sobre la aplicación de restricción. Conclusiones: Basado en los resultados se concluye que las imágenes publicadas en Twitter sobre la aplicación de la restricción y aislamiento, están relacionados con los siguientes aspectos: Educar a otros sobre el tema, mostrar la espacialidad en la aplicación de la restricción, la percepción que se tiene sobre la restricción según las personas y objetos, y la connotación sociopolítica. Esto significa que las publicaciones de Twitter ofrecen a las enfermeras la oportunidad de participar en marketing social y connotar una dimensión ética a una persona asociada con medidas utilizadas para ejercer poder sobre los demás, ya que la comunicación sobre ciertos temas controvertidos en el cuidado de la salud está libre de jerarquías en Twitter.Objetivo: Determinar as áreas de discussão sobre a aplicação de isolamento e restrição no campo da saúde, com base nos motivos publicados no Twitter. Materiais e método: Uma abordagem qualitativa baseada em um desenho observacional transversal e de arquivo foi aplicada na investigação. Foram analisadas 188 imagens publicadas no Twitter. Resultados: foram identificadas cinco categorias: mensagens informativas e educativas; equipamentos como artefatos; espacialidade; os sujeitos a quem são aplicadas restrições e conotações sociopolíticas na aplicação da restrição. Conclusões: Com base nos resultados, conclui-se que as imagens publicadas no Twitter sobre a aplicação da restrição e isolamento estão relacionadas aos seguintes aspectos: Educar outros sobre o assunto, mostrar a espacialidade na aplicação da restrição, a percepção de que Trata-se de restrição de acordo com pessoas e objetos e conotação sócio-política. Isso significa que as postagens no Twitter oferecem aos enfermeiros a oportunidade de participar de marketing social e conotam uma dimensão ética a uma pessoa associado a medidas usadas para exercer poder sobre os outros como comunicação sobre certas questões controversas na área da saúde estão livres de hierarquias no Twitter

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

Being perceived as a 'visitor' in the nursing staff's working arena--the involvement of relatives in daily caring activities in nursing homes in an urban community in Sweden

It is both complex and difficult for relatives when a loved one moves into a nursing home and many relatives are not prepared for the realities these new situations entail. Little attention has been paid to scrutinising the involvement of relatives in patient care, particularly in relation to the structures and routines of nursing homes or to the staff's reasoning concerning their involvement

The impact of mental health recovery narratives on recipients experiencing mental health problems: Qualitative analysis and change model.

BACKGROUND: Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD: Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS: Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS: Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing

Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study

Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants’ experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed

Practical compassions: repertoires of practice and compassion talk in acute mental healthcare

This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record-keeping and internal processes of quality control were seen as time-greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau-Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power

Parenting and digital media: from the early days of the web to contemporary digital society.

Parents have accessed websites, online discussion forums and blogs for advice, information and support since the early days of the World Wide Web. In this article, we review the literature in sociology and related social research addressing the ways in which digital media have been used for parenting-related purposes. We begin with the longer-established media of parenting websites, online discussion forums, blogs, email, mobile phones and message and video services and then move on to the newer technologies of social media and apps. This is followed by a section on data privacy and security issues. The concluding section summarises some major issues arising from the review and points to directions for further research