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Romm KL, Skoge M, Barrett EA, Berentzen LC, Bergsager D, Fugelli P, Bjella T, Gardsjord ES, Kling K, Kruse SH, Kværner KJ, Melle I, Mork E, Ihler HM, Rognli EB, Simonsen C, Værnes TG, Aminoff SR. A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability. JMIR Form Res 2025; 9:e57614. [PMID: 39823632 PMCID: PMC11786142 DOI: 10.2196/57614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 10/28/2024] [Accepted: 11/06/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. OBJECTIVE This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. METHODS We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. RESULTS To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. CONCLUSIONS iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings-from development to implementation-and to conduct further research on early health technology assessments to guide these processes.
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Affiliation(s)
- Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mari Skoge
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elizabeth Ann Barrett
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lars-Christian Berentzen
- Section for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Dagfinn Bergsager
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Pål Fugelli
- University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Thomas Bjella
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Strand Gardsjord
- Section for Early Intervention in Psychosis, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristine Kling
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sindre Hembre Kruse
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kari Jorunn Kværner
- Centre for Connected Care (C3), Oslo University Hospital, Oslo, Norway
- BI Norwegian Business School, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Clinical Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Henrik Myhre Ihler
- Nydalen DPS, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eline Borger Rognli
- Section for Clinical Addiction Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tor Gunnar Værnes
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sofie Ragnhild Aminoff
- Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Arturén H, Zetherström J, Sjöström N, Abrams D, Johansson L. Handling conflict situations in psychosis inpatient care: Nursing staff experiences of the Interactive Approach model. J Psychiatr Ment Health Nurs 2024; 31:1083-1092. [PMID: 38796785 DOI: 10.1111/jpm.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In inpatient wards, there is a risk that conflicts occur when nursing staff interact with psychotic patients. The Interactive Approach (IA) model is an action-based model, used in psychiatric settings, to manage conflict situations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The IA model can be used to improve communication between nursing staff and patients in numerous critical situations. Using a structured risk scale to evaluate a conflict can be an effective way to guide action and sort out the different aspects of communication between nursing staff and psychotic patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The clarity of an action-based model will help sort out which interventions are most likely to succeed in each conflict situation. The IA model highlights the importance of understanding and strengthening the patient's perspective, being flexible for each individual patient, and providing the patient with clear information about the situation. ABSTRACT: Introduction The Interactive Approach (IA) model is a structured management tool used to improve communication between caregivers and patients in psychiatric care settings. Aim/Question To examine the nursing staff's experiences of the IA model. How do they use the interventions in conflict situations with psychotic patients? Method A sample of nursing staff (n = 11) was recruited from three psychosis inpatient care units. Semi-structured questions covered staff experiences of working with the problem-solving interventions in the IA model. Transcribed data were analysed by qualitative content analysis. Results Three categories were defined: (1) 'To apply a flexible approach' describes how staff tried to adapt to each patient and situation; (2) 'Try to understand the person's inner world' describes the importance of active listening and exploring the patient's concerns; and (3) 'To communicate clearly' relates to experiences of clear communication and the setting up of boundaries. Discussion The risk scale and training in communication skills helped the interaction between staff and patients in conflict situations. Different interventions were used with a focus on maintaining patient alliance. Implications for Practice The findings highlight the importance of educational efforts and practical training, to prevent violence and the use of coercive measures.
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Affiliation(s)
- Hanna Arturén
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Zetherström
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nils Sjöström
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Abrams
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Johansson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
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Rodwell D, Frith H. Using a trauma-informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings. Int J Ment Health Nurs 2024; 33:1139-1150. [PMID: 38291657 DOI: 10.1111/inm.13300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma-informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.
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Affiliation(s)
- Devon Rodwell
- School of Psychology, University of Surrey, Guildford, UK
| | - Hannah Frith
- School of Psychology, University of Surrey, Guildford, UK
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Igarashi M, Kawaguchi T, Shiozawa T, Yamaguchi S. Conversation topics in psychiatric consultations conducted with and without a shared decision-making tool: A qualitative content analysis. PATIENT EDUCATION AND COUNSELING 2024; 118:108045. [PMID: 37925974 DOI: 10.1016/j.pec.2023.108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To identify 1) conversation topics, 2) who initiated the topics, and 3) differences in topics with and without the use of a shared decision-making (SDM) tool in psychiatric outpatient consultations. METHODS We conducted qualitative content analysis of audio-recorded and transcribed data of psychiatric outpatient consultations. We included 52 participants - 25 in the SDM group and 27 in the treatment as usual (TAU) group - and 104 consultations were analyzed, two per participant. The word count per topic was calculated using the transcripts. RESULTS Five categories for 28 topics were generated. The categories and percentages of word count were: (1) symptoms: 26.1%, (2) life: 37.4%, (3) treatment/service use: 16.3%, (4) global state/goal: 7.3%, and (5) others: 12.9%. The SDM tool significantly increased the overall conversation word count and consultation time. No significant difference was observed for the topic distribution between the two groups. CONCLUSION Daily life issues - especially those related to work - were the main topics discussed in psychiatric consultations. The SDM tool seems to facilitate discussion of patients' concerns, but the topic distribution is likely to be similar regardless of whether or not the SDM tool was used. PRACTICE IMPLICATIONS Outpatient psychiatrists are expected to effectively address life-related issues.
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Affiliation(s)
- Momoka Igarashi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan; Nursing Innovation Research Center, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.
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Berg J, Lipponen E, Sailas E, Soininen P, Varpula J, Välimäki M, Lahti M. Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study. J Psychiatr Ment Health Nurs 2023. [PMID: 36718606 DOI: 10.1111/jpm.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.
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Affiliation(s)
- Johanna Berg
- Turku University of Applied Sciences, Turku, Finland
| | | | - Eila Sailas
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland
| | - Päivi Soininen
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya Nursing School, Central South University, Changsha, China
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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Bergen C, Bortolotti L, Tallent K, Broome M, Larkin M, Temple R, Fadashe C, Lee C, Lim MC, McCabe R. Communication in youth mental health clinical encounters: Introducing the agential stance. THEORY & PSYCHOLOGY 2022; 32:667-690. [PMID: 36090764 PMCID: PMC9445400 DOI: 10.1177/09593543221095079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When young people seek support from mental health care practitioners, the encounters may affect the young people's sense of self, and in particular undermine their sense of agency. For this study, an interdisciplinary team of academics and young people collaboratively analysed video-recorded encounters between young people and mental healthcare practitioners in emergency services. They identified five communication techniques that practitioners can use to avoid undermining the young person's sense of agency in the clinical encounter. They conceptualise the use of those techniques as the adoption of an agential stance towards the young person. The agential stance consists of: (a) validating the young person's experiences, (b) legitimising the young person's choice to seek help, (c) refraining from objectifying the young person, (d) affirming the young person's capacity to contribute to positive change, and (e) involving the young person in the decision-making process.
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Kibitov A, Chumakov E, Nechaeva A, Sorokin M, Petrova N, Vetrova M. Professional Values and Educational Needs among Mental Health Specialists in Russia: Survey Results. CONSORTIUM PSYCHIATRICUM 2022; 3:35-44. [PMID: 39044919 PMCID: PMC11262121 DOI: 10.17816/cp184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Exploring the professional values and educational needs of future and practicing mental health specialists is required to develop effective measures aiming at improving their skills and interest in their work. AIM Our aim was to explore professional values and educational needs of mental health specialists in Russia. METHODS We conducted a survey that captured socio-demographic data, professional characteristics, professional values, and educational needs. Fisher's exact test, logistic regression, and the k-means cluster analysis were used in our statistical analysis. RESULTS The survey included 133 participants, 71% of whom had completed their postgraduate education. The following items were mentioned as important professional values by the respondents: "Job opportunities", "Stimulation of intellectual activity", and "Work-life balance". The most popular options for educational activities were English language (63.4%), the principles of evidence-based medicine (63.4%), and developing skills for conducting scientific research (59.4%).In comparison with practicing specialists, respondents who had not yet completed their postgraduate education were more interested in developing their curriculum vitae (39% vs. 60%, p=0.044) and communication skills (49% vs. 77%, p=0.0048). Compared to male respondents, female respondents were more interested in developing skills in conducting scientific research (47 vs. 70%, p=0.0165).A cluster analysis showed that specialists who attached more importance to almost all professional values, in comparison to those who did not, were more interested in activities aimed at developing their research skills (64% vs. 41%, p=0.0287), learning about the principles of evidence-based medicine (70% vs. 41%, p=0.0063), and participating in journal clubs (39% vs. 11%, p=0.0193). CONCLUSION The present study suggests that job opportunities, intellectual stimulation, and work-life balance are the most important professional values for future and practicing mental health specialists. These findings might be used as a basis for developing educational activities for mental health specialists.
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Cole C, Klotz E, Junghanss J, Oster A, Bermpohl F, Vandamme A, Mahler L. Patient communication ability as predictor of involuntary admission and coercive measures in psychiatric inpatient treatment. J Psychiatr Res 2022; 153:11-17. [PMID: 35792341 DOI: 10.1016/j.jpsychires.2022.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
Coercive measures (CM) and involuntary admission to psychiatric treatment can have detrimental consequences for patients. Past research shows that certain clinical, treatment and admission-related characteristics put patients at a higher risk of experiencing CM and involuntary admission. Although of high societal importance, the association between patients' communication ability and CM and involuntary admission has not been subject of past research. To explicitly examine this association the authors conducted a retrospective study using data from patients admitted to psychiatric inpatient treatment via the emergency room at Charité St. Hedwig Hospital, Berlin in 2019. As independent variable, communication ability at admission was recorded (perfect; limited due to language or other reasons; impossible due to language or other reasons) along with possibly confounding variables including demographic, clinical and admission-related details. As dependent variables, involuntary admission and CM were recorded. Multivariate logistic regression analyses were conducted examining the association between communication ability and involuntary admission and CM. In a sample of N = 1556, controlling for potential confounders, limited (OR = 3.08; p = .004) or no communication ability (OR = 4.02; p = .003) due to language barrier or limited (OR = 3.10; p < .001) or no communication ability (OR = 13.71; p < .001) due to other factors were significant predictors for involuntary admission. Limited communication ability due to language barrier (OR = 4.53; p < .001) and limited (OR = 1.58; p = .034) and no communication ability (OR = 3.55; p < .001) due to other factors were significant predictors for CM. These findings show that patients impaired in their communication ability are at higher risk of involuntary admission and CM and highlight the urgency of implementing appropriate interventions facilitating communication during admission and treatment.
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Affiliation(s)
- Celline Cole
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany.
| | - Eva Klotz
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Julia Junghanss
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Anna Oster
- Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Potsdamer Chaussee 69, 14129, Berlin, Germany
| | - Felix Bermpohl
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Angelika Vandamme
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany
| | - Lieselotte Mahler
- Charité University Medicine Berlin, Department of Psychiatry at St. Hedwig Hospital (PUK Charité im SHK), Grosse Hamburger Str. 5-11, 10115, Berlin, Germany; Department of Psychiatry and Psychotherapy, Clinics in the Theodor-Wenzel-Werk, Potsdamer Chaussee 69, 14129, Berlin, Germany
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Ditton-Phare P, Sandhu H, Kelly B, Loughland C. ComPsych communication skills training: Applicability of simulated patients in psychiatry communication skills training. Australas Psychiatry 2022; 30:552-555. [PMID: 35138955 DOI: 10.1177/10398562211067199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Communication skills training (CST) programs within postgraduate psychiatry training are rare. ComPsych CST utilises simulated patients (SPs) for trainees to practice communication skills for discussing severe mental illness with patients and their families/carers. This study examined the applicability of using SPs in a psychiatry-specific CST. METHODS A total of 41 postgraduate psychiatry trainees attended at least one of four modules of training in their cohort year and completed a questionnaire after each module presenting eight questions rating the use of SPs and ratings of course deliverables. RESULTS Overall, trainees rated contact with SPs very highly across all modules, with a mean rating of 9.11 out of 10 (SD = 0.97). Trainees agreed that SPs appeared authentic, that their reactions showed they listened to the trainee. CONCLUSIONS Trainees valued training with SPs, providing evidence that using SPs for psychiatry-specific CST is feasible. Despite subjectivity, this is valuable to course providers as it highlights benefits perceived by trainees to be useful and provides further evidence for the program's feasibility and utility.
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Affiliation(s)
- Philippa Ditton-Phare
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Harsimrat Sandhu
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia
| | - Brian Kelly
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
| | - Carmel Loughland
- 278707Hunter New England Mental Health, Newcastle, NSW, Australia.,School of Medicine and Public Health, 64834Faculty of Health University of Newcastle, Callaghan, Newcastle, NSW, Australia.,Centre for Brain and Mental Health Research, Mater Hospital Campus, Newcastle, NSW, Australia.,Hunter Medical Research Institute, John Hunter Hospital Campus, Newcastle, NSW, Australia
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Dondé C, Pouchon A, Pelluet A, Bougerol T, Polosan M. The Impact of Wearing a Face Mask on the Psychiatric Interview: a National Survey During the COVID-19 Pandemic. Psychiatr Q 2022; 93:435-442. [PMID: 34626317 PMCID: PMC8501330 DOI: 10.1007/s11126-021-09962-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/20/2023]
Abstract
The COVID-19 pandemic has forced to rapidly encourage the use of face masks during medical consultations, with significant implication for psychiatry. This study examined the opinions and attitudes of psychiatrists toward the impact of wearing a face mask on the psychiatric interview. 513 psychiatrists and trainee psychiatrists completed an electronic survey about the impact of wearing a face mask on the psychiatric interview. Less efficiency in capturing clinical signs/symptoms, emergence of false inferences in patients and altered patient-clinician interactions were commonly reported negative impacts of face mask (66-96%). The quality of the therapeutic alliance was reported as affected by the mask by 47% of the sample. Results were mixed on the use of telepsychiatry as a potential solution to mask-related inconvenience. The use of face masks has significant negative effects on the psychiatric interview. Providing specific training to clinicians could be a potential solution for masks-induced biases.
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Affiliation(s)
- Clément Dondé
- Univ. Grenoble Alpes, F-38000, Grenoble, France. .,INSERM, U1216, F-38000, Grenoble, France. .,Adult Psychiatry Department, CHU Grenoble Alpes, F-38000, Grenoble, France. .,Adult Psychiatry Department, CH Alpes-Isère, F-38000, Saint-Egrève, France.
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, F-38000, Grenoble, France.,INSERM, U1216, F-38000, Grenoble, France.,Adult Psychiatry Department, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Albane Pelluet
- Université, Université de Lyon, Claude Bernard Lyon 1, Lyon, France.,Service de Psychopathologie du Développement de l'Enfant et de l'Adolescent, Femme-Mère-Enfant, HôpitalHospices Civils de Lyon, Bron, France
| | - Thierry Bougerol
- Univ. Grenoble Alpes, F-38000, Grenoble, France.,INSERM, U1216, F-38000, Grenoble, France.,Adult Psychiatry Department, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, F-38000, Grenoble, France.,INSERM, U1216, F-38000, Grenoble, France.,Adult Psychiatry Department, CHU Grenoble Alpes, F-38000, Grenoble, France
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11
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Ditton-Phare P, Sandhu H, Kelly B, Loughland C. Does ComPsych Communication Skills Training Alter Trainee Self-Efficacy? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:303-310. [PMID: 34553322 DOI: 10.1007/s40596-021-01517-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE ComPsych communication skills training is designed to teach psychiatry trainees effective skills and strategies for undertaking key communication tasks relating to mental illness, such as schizophrenia, with patients and their families/carers. This study examined the program's feasibility, utility, and trainees' self-efficacy. METHODS Trainee cohorts attending their first year formal education course were recruited annually over 4 years between 2015 and 2018. Each trainee attended at least one session of training in their cohort year. Trainees completed a questionnaire presenting questions about personal demographics, their perceived confidence in communication, and the effectiveness of elements of training delivery. A total of 41 trainee psychiatrists (15 male) completed the questionnaires presented at four time points (two pre-training and two post-training). RESULTS Participants reported a significant increase in confidence in their own communication skills post-training (d = 1.12) and rated elements of training delivery (video feedback, feedback from peers in small groups, small group facilitation, and use of simulated patients) as significantly more helpful or effective post-training (d = 0.42). Trainees also reported a significantly increased ability to critically evaluate their own communication skills post-training (d = 0.59), suggesting an increased ability to recognize their own communication skill competence. CONCLUSIONS Following ComPsych training, trainees were more confident discussing information about schizophrenia with patients and their families/carers and were more able to critically evaluate their own communication skills: an important feature of good clinical acumen. These subjective ratings provide important self-efficacy information, including the benefits perceived and evidence of the program's feasibility and utility.
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Affiliation(s)
| | | | - Brian Kelly
- University of Newcastle, Callaghan, Newcastle, NSW, Australia
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12
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Yıldız E. What Do Nursing Students Tell Us About Their Communication With People With Mental Illness? A Qualitative Study. J Am Psychiatr Nurses Assoc 2021; 27:471-482. [PMID: 31795795 DOI: 10.1177/1078390319892311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Communication with individuals with mental disorder (IMDs) may often be a nonlinear, complex, and variable situation. In general, the first contact of nurses with IMDs occurs during training rotations at a psychiatric clinic. Psychiatric nursing students' initial communication experiences with IMDs may be critical to their thinking of psychiatric nursing as a career. AIM To determine the communication experiences of psychiatric nursing students with IMDs. METHOD A qualitative interview study was conducted with psychiatric nursing students studying at a nursing faculty in the east of Turkey in 2019 who completed the clinical practice. Semistructured interviews were conducted by an independent researcher. The data were analyzed using content analysis with an inductive approach. RESULTS In this study, maximum effort was made for data saturation criteria, and data saturation was achieved with 26 students. As a result of the data analysis, four main themes and 11 categories were developed. The main themes were as follows: (1) restrictions caused by psychological barriers, (2) restrictions caused by thinking and perceptions, (3) restrictions caused by personal and behavioral barriers, and (4) effective communication and therapeutic environment. CONCLUSIONS In this study, although it is seen that nursing students encounter many communication barriers with IMDs, it is an important development that they implement approaches to provide effective therapeutic communication. The results show the importance of effective nurse-patient communication skills as the first step in improving the clinical practice of nurses in psychiatry clinics.
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Affiliation(s)
- Erman Yıldız
- Erman Yıldız, PhD, Inonu University, Malatya, Turkey
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13
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Böhm M, Stiglbauer B. [Motives for the use of psychosocial aftercare services]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2021; 36:97-103. [PMID: 34383252 DOI: 10.1007/s40211-021-00397-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are hardly any studies regarding the specific motives for the use of psychosocial aftercare services. The present study aims to fill this gap by investigating the motives for the use of certain psychosocial aftercare services for people with mental health problems. In particular, the services Ability-Oriented Activity, Mobile Care and Help, Psychosocial Counseling Center and Housing are considered. METHODS Data from a client satisfaction surveys which had been conducted on an annual basis over a period of 5 years (2013-2017) were analyzed. Clients were surveyed regarding the importance of 5 motives for service use (getting support with problems; being able to talk to someone about problems; feeling understood; having a space of safety; feeling like they are doing something for their health) using a 5-point response scale. RESULTS AND CONCLUSIONS The analyses of the data show that across all services, the motive "feeling understood" is of great importance for the use of psychosocial services. Apart from this motive, it is primarily safety that motivate the use of services of ability-oriented activity and housing. In the case of Mobile Care and Assistance and the Psychosocial Counseling Center, it is predominantly instrumental aspects, such as getting support with problems. In general, it can be seen that the motivational strength, i.e. how important these reasons are for using the service, is highest for the services provided by Mobile Care and Assistance and the Psychosocial Counseling Center.
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Affiliation(s)
- Martin Böhm
- Abteilung Qualitätsmanagement, pro mente Oberösterreich, Lonstorferplatz 1, 4020, Linz, Österreich.
| | - Barbara Stiglbauer
- Institut für Pädagogik und Psychologie, Johannes Kepler Universität Linz, Linz, Österreich
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14
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Petkari E, Kaselionyte J, Altun S, Giacco D. Involvement of informal carers in discharge planning and transition between hospital and community mental health care: A systematic review. J Psychiatr Ment Health Nurs 2021; 28:521-530. [PMID: 33053271 DOI: 10.1111/jpm.12701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Family members and friends (informal carers) are very important for providing support to people with mental health difficulties. When these carers are included to care planning patients seem to benefit, as they are less likely to relapse. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE There are three types of interventions including carers in the patients'transition 1) programmes that offer education in hospital; 2) programmes that involve carers in planning the patients discharge; and 3) programmes that involve carers in hospital care, discharge planning and also follow-up in the community. Interventions including carers that take place both in the hospital and the community have the clearest evidence for benefit on relapse reduction. WHAT ARE THE IMPLICATIONS FOR PRACTICE Comprehensive interventions have the best evidence for effectiveness but challenges in their implementation and resourcing should be considered. It might worth trying to identify and test simpler interventions focusing on discharge planning that can be used in busy services and require more limited resources whilst providing opportunities for the participation of carers. ABSTRACT INTRODUCTION: Involving informal carers (family and friends of patients) in mental health interventions can lead to positive clinical and psychosocial outcomes such as relapse prevention or treatment adherence. AIM/QUESTION To explore the evidence on the effectiveness of different models that involve carers in the transition between hospital and community mental health care. METHODS Five electronic databases (PsycINFO, CINAHL, MEDLINE, Embase and Scopus) and Grey literature (Open Grey and Grey Literature report) were systematically searched. The results were analysed using a narrative synthesis. RESULTS Fourteen papers were identified. They described twelve interventions that were categorized into three groups: 1) purely educational programmes in preparation of discharge; 2) programmes that involved carers in planning the transition from the mental health inpatient treatment to community mental health services; and 3) programmes that bridged into the aftercare involving carers in community follow-up. The most comprehensive interventions, i.e. those including psychoeducation, care planning and aftercare follow-up were better evaluated and showed a clearer benefit in improving long-term outcomes and, in particular, reduce re-hospitalization. IMPLICATIONS FOR PRACTICE Comprehensive interventions showed the clearest benefit in improving long-term clinical outcomes of patients. Future research should explore implementation, costs and cost-effectiveness, as comprehensive interventions delivered across different settings are likely to require wide-ranging organizational changes and significant resources.
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Affiliation(s)
- Eleni Petkari
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK
| | - Justina Kaselionyte
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK
| | | | - Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Mary University of London, London, UK.,Warwick Medical School, University of Warwick, Coventry, UK
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15
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Chowdhury P, Tari A, Hill O, Shah A. To improve the communication between a community mental health team and its service users, their families and carers. BMJ Open Qual 2021; 9:bmjoq-2020-000914. [PMID: 33154096 PMCID: PMC7646348 DOI: 10.1136/bmjoq-2020-000914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022] Open
Abstract
This article describes the application of quality improvement (QI) to solve a long-standing, ongoing problem where service users or their carers felt they were not given enough information regarding diagnosis and medication during clinic assessments in a community mental health setting. Service users and carers had shared feedback that some of the information documented on clinic letters was not accurate and the service users were not given the opportunity to discuss these letters with the clinician. The aim of this QI project was to improve the communication between the community mental health team (CMHT) and service users and their carers. Wardown CMHT volunteered to take on this project. The stakeholders involved were the team manager and deputy manager, the team consultant, the team specialist registrar, team administrative manager, two carers and one service user. The project had access to QI learning and support through East London NHS Foundation Trust’s QI programme. The team organised weekly meetings to brainstorm ideas, plan tests of change to review progress and to agree on the next course of action. The outcome was an increase in service user satisfaction from 59.9% to 78% over a period of 6 months, and a reduction in complaints to zero.
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Affiliation(s)
| | - Amir Tari
- Psychiatry, East London NHS Foundation Trust, Luton, UK
| | - Ola Hill
- East London NHS Foundation Trust, London, UK
| | - Amar Shah
- Psychiatry, East London NHS Foundation Trust, Luton, UK
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16
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Cassidy C, Miles W. New Zealand community mental healthcare provider experience in schizophrenia management with 3-monthly paliperidone palmitate. Australas Psychiatry 2021; 29:299-304. [PMID: 32586110 PMCID: PMC8170367 DOI: 10.1177/1039856220928867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To understand the impact of 3-monthly treatment with paliperidone palmitate on patient management, including non-adherence and relapse, from a psychiatrist and nurse perspective for 73 patients enrolled in a patient familiarisation programme (PFP) in New Zealand. METHODS An online questionnaire was sent to clinicians with at least 6 months of regular interaction with PFP patients. Questions addressed treatment effectiveness and patient management changes. Analyses are descriptive only and do not represent patient or carer perspectives. RESULTS Seven psychiatrists, representing 58 of 73 (79.5%) of patients, and 17 nurses responded to the survey. Psychiatrists were satisfied with efficacy and tolerability and relapse prevention. Treatment goals were either 'met' (2/7; 28.6%) or 'exceeded' (5/7; 71.4%). The focus on adherence issues decreased and the focus on life areas and recovery goals increased. CONCLUSIONS From the clinician perspective, 3-monthly paliperidone palmitate offers patients the potential to remain adherent and improve social functioning.
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Affiliation(s)
| | - Wayne Miles
- Waitemata District Health Board Research and Knowledge Centre, New Zealand; and Department of Psychological Medicine, University of Auckland, New Zealand
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17
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Nguyen A, Frobert L, Ismailaj A, Monteiro S, Favrod J. Qu’est-ce que les professionnels dévoilent d’eux-mêmes dans la relation thérapeutique avec les personnes atteintes de schizophrénie ? PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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‘I’m Not Going to Tell You Cos You Need to Think About This’: a Conversation Analysis Study of Managing Advice Resistance and Supporting Autonomy in Undergraduate Supervision. POSTDIGITAL SCIENCE AND EDUCATION 2020. [PMCID: PMC7588590 DOI: 10.1007/s42438-020-00194-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article, firstly, critically analyses a face-to-face supervision meeting between an undergraduate and a supervisor, exploring how the supervisor handles the twin strategies of fostering autonomy while managing resistance to advice. Conversation analysis is used as both a theory and a method, with a focus on the use of accounts to support or resist advice. The main contribution is the demonstration of how both the supervisor and the student are jointly responsible for the negotiation of advice, which is recycled and calibrated in response to the student’s resistance. The supervisor defuses complaints by normalising them, and moving his student on to practical solutions, often with humour. He lists his student’s achievements as the foundation on which she can assert agency and build the actions he recommends. Supervisor-student relationships are investigated through the lens of the affective dimensions of learning, to explore how caring or empathy may serve to reduce resistance and make advice more palatable. By juxtaposing physically present supervision with digitally mediated encounters, while acknowledging their mutual entanglement, the postdigital debate is furthered. In the context of Covid-19, and rapid decisions by universities to bring in digital platforms to capture student-teacher interactions, the analysis presented is in itself an act of resistance against the technical control systems of the academy and algorithmic capitalism.
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19
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Lu W, Ngai CSB, Yang L. The Importance of Genuineness in Public Engagement-An Exploratory Study of Pediatric Communication on Social Media in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7078. [PMID: 32992635 PMCID: PMC7579357 DOI: 10.3390/ijerph17197078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
There is a growing need for the public to interact with pediatricians through social media in China, and genuineness is a crucial factor contributing to effective communication, but few studies have examined the relationship between genuineness and its effect on public engagement. This study developed a four-dimension framework including self-disclosure, genuine response, functional interactivity, and genuineness in Chinese culture to investigate the effect of genuineness in the communication of Chinese social media influencers in pediatrics on public engagement. Content analysis was employed to examine these dimensions and the related public engagement in 300 social media posts on the largest microblogging site in China. The findings indicate that genuine response was positively associated with the number of comments and positive comments, while negatively related to the number of shares. Functional interactivity made the site more appealing, resulting in likes and shares. Genuineness in Chinese culture was reflected in engagement through sharing posts by the public. This study is the first to develop an integrated framework to measure genuineness in online health communication and contributes to the understanding of the effect of genuineness on Chinese public engagement in social media.
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Affiliation(s)
| | - Cindy Sing Bik Ngai
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR HK, China; (W.L.); (L.Y.)
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20
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Tullio V, Zerbo S, Lanzarone A, Procaccianti S, Argo A. Psychological and Medico-Legal Perspectives on Electroconvulsive Therapy and Patient-Centered Care: A Short Review of Cross-Cutting Issues. THE OPEN PSYCHOLOGY JOURNAL 2020; 13:253-263. [DOI: 10.2174/1874350102013010253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 01/03/2025]
Abstract
Electroconvulsive therapy is a treatment that, since its first administration, has been a major topic for debate within the scientific world. In recent years, the debate has become increasingly focused on the short- and/or long-term efficacy of electroconvulsive therapy, its appropriateness in clinical settings, its mechanism of action, the impact evaluation of transient and/or persistent adverse effects, and the drafting of international guidelines,etc.From the authors’ point of view, these themes are inevitably crossed by three other fundamental issues of significant psychological, relational, ethical, and medico-legal impact. Still, they are less studied than purely biomedical issues in recent times. Therefore, the aim of this article is to focus on the following cross-cutting issues: the therapist-patient relationship, the patient’s perspective, the attitude on electroconvulsive therapy, and informed consent.This short review refers to the international literature on ECT published since 2000. Analyses of the three previously listed topics are, in part, made within the context of Italian medical settings.
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21
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Pal A, Gupta P, Parmar A, Sharma P. 'Masking' of the mental state: Unintended consequences of personal protective equipment (PPE) on psychiatric clinical practice. Psychiatry Res 2020; 290:113178. [PMID: 32535497 PMCID: PMC7270791 DOI: 10.1016/j.psychres.2020.113178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Arghya Pal
- Assistant Professor, Department of Psychiatry, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Prashant Gupta
- International Psychiatry Fellow, Barnet, Enfield and Haringey Mental Health (NHS) Trust, London, UK
| | - Arpit Parmar
- National consultant (Harm Reduction), National AIDS Control Organization, Janpat, New Delhi, India
| | - Pawan Sharma
- Lecturer, Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal.
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Drissi N, Ouhbi S, Idtissi MAJ, Ghogho M. Mobile Apps for Post Traumatic Stress Disorder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4279-4282. [PMID: 31946814 DOI: 10.1109/embc.2019.8857197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Post Traumatic Stress Disorder (PTSD) is a serious mental disorder that is caused by exposure to traumatic stress and not being able to recover from it. PTSD often results in a severe reduction of the quality of life, and is significantly associated with the risk of suicide. This paper identifies the current list of free mobile applications (apps) available in Android platform for smartphone users with PTSD. This paper also assesses the functionalities of the apps selected. The result of this study may assist PTSD apps seekers for self-support, and serve as a reference for researchers and developers, who intend proposing stress management apps.
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23
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Akiba CF, Zimba CC, Thom A, Matewere M, Go V, Pence B, Gaynes BN, Masiye J. The role of patient-provider communication: a qualitative study of patient attitudes regarding co-occurring depression and chronic diseases in Malawi. BMC Psychiatry 2020; 20:243. [PMID: 32429877 PMCID: PMC7236218 DOI: 10.1186/s12888-020-02657-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients' attitudes and perceptions towards depression integration into routine NCD services. METHODS Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N = 20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. RESULTS While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients' respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider's communication in shaping a patient's feelings about depression. CONCLUSIONS Training and interventions that facilitate providers' abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. TRIAL REGISTRATION This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018.
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Affiliation(s)
- Christopher F Akiba
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA.
| | - Chifundo C Zimba
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Annie Thom
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Maureen Matewere
- University of North Carolina Project Malawi, Tidziwe Center, 100 Mzimba Road, Private Bag A, /104, Lilongwe, Malawi
| | - Vivian Go
- Department of Health Behavior, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Brian Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 2103C McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, School of Medicine, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Jones Masiye
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
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Carpiniello B, Wasserman D. European Psychiatric Association policy paper on ethical aspects in communication with patients and their families. Eur Psychiatry 2020; 63:e36. [PMID: 33289623 PMCID: PMC7355125 DOI: 10.1192/j.eurpsy.2020.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Establishing a valid communication is not only a basic clinical need to be met but also a relevant ethical commitment. METHODS On the basis of the relevant literature, ethical issues arising from specific, important situations in clinical practice were identified. RESULTS The main ethical problems regarding communication about the disorder, both in general and in relation to prodromal stages, were described and discussed together with those regarding communication about voluntary and involuntary treatments, "dual roles" enacted in clinical practice, genetic counseling, and end-of-life conditions; on the basis of what emerged, ethically driven indications and suggestions were provided. CONCLUSIONS Several situations put the psychiatrist in front of relevant dilemmas and doubts which are no easy to face with; an ethically driven approach based upon the principle of the best interest of patients may support clinicians in their decisions.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Medical Science and Public Health, Psychiatric Unit, University Hospital Cagliari, Cagliari, Italy
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) LIME, Karolinska Institutet-CHIS, Stockholm, Sweden
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25
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What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 PMCID: PMC8061300 DOI: 10.1017/s2045796019000428] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
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Stubbe DE. Optimizing Adherence: Bipolar Disorder and the Therapeutic Motivational Alliance. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:262-264. [PMID: 32047372 PMCID: PMC6999207 DOI: 10.1176/appi.focus.20190011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Dorothy E Stubbe
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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McGonagle G, Bucci S, Varese F, Raphael J, Berry K. Is adult attachment associated with engagement with services? A systematic literature review. J Ment Health 2019; 30:607-618. [DOI: 10.1080/09638237.2019.1608922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- G. McGonagle
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S. Bucci
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - F. Varese
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Raphael
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - K. Berry
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jaeger S, Hüther F, Steinert T. Refusing Medication Therapy in Involuntary Inpatient Treatment-A Multiperspective Qualitative Study. Front Psychiatry 2019; 10:295. [PMID: 31139098 PMCID: PMC6520436 DOI: 10.3389/fpsyt.2019.00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: Between June 2012 and February 2013, two decisions by the German Federal Constitutional Court restricted the so-far common practice to use involuntary medication in inpatients who were involuntarily hospitalized. Up to then, involuntary medication was justified by a judge's decision on involuntary hospitalization. It could be applied according to clinical judgment even against the declared will of a patient. Since then, all domestic laws related to involuntary treatment had to be revised. For several months, involuntary medication was allowed only in an emergency. We were interested in the impact of the changed legal framework on the experiences of inpatients, their relatives, and clinical professionals during that time. Methods: Thirty-two interviews were analyzed qualitatively using a grounded theory methodology framework. Results: As a consequence of the restrictions to involuntary medication, special efforts by nursing and medical staff were required concerning de-escalation, ward management, and the promotion of treatment commitment in inpatients who refused medication. Family caregivers were also under strong pressure. They wanted to help and to protect their relatives, but some also welcomed the use of coercion if the patient refused treatment. Most of the interviewed patients had not even noticed that their rights to refuse medication had been strengthened. They complained primarily about the involuntary hospital stay and the associated limitations of their everyday lives. While patients and family members evaluated the refusal of medication from a biographical perspective, the mental health care professionals' focus was on the patients' symptoms, and they understood the situation from a professional perspective. It was obvious that, in any of the four perspectives, the problem of feeling restricted was crucial and that all groups strived to gain back their scope of action. Conclusion: The temporary ban on involuntary medication questioned the hitherto common routines in inpatient treatment, in particular when patients refused to take medication. Each of the different groups did not feel good about the situation, for different reasons, however. As a consequence, it might be indispensable to increase awareness of the different perspectives and to focus the efforts on the establishment of nonviolent treatment structures and practices.
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Affiliation(s)
- Susanne Jaeger
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
| | - Franziska Hüther
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Tilman Steinert
- Department of Psychiatry I, Ulm University, Centre for Psychiatry Suedwuerttemberg, Health Services Research Weissenau, Ravensburg, Germany
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Ertem MY, Duman ZÇ. The effect of motivational interviews on treatment adherence and insight levels of patients with schizophrenia: A randomized controlled study. Perspect Psychiatr Care 2019; 55:75-86. [PMID: 29888541 DOI: 10.1111/ppc.12301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To examine the effect of motivational interview (MI) on treatment adherence and insight of the patients diagnosed with schizophrenia at a hospital in Turkey. DESIGN AND METHODS Individuals with schizophrenia, who match with the sample characteristics, were assigned to intervention (20) and control groups (20) according to the randomization schedule. Personal Information Form, Self-Reported Measure of Medication Adherence, and Schedule for Assessing the Three Components of Insight were used. FINDINGS Group-wise examinations showed that mean scores of "three component scales of insight" yielded statistically significant difference for the intervention group. Analysis of the Treatment Adherence Scale Mean Scores showed a significant difference for interval mean scores of the intervention group. PRACTICE IMPLICATIONS Both the pyschiatric patients and the health institutions can benefit from increased levels of treatment adherence and insight by the adoption of the MI methods starting with a patient's first registration to a psychiatric outpatient clinic. IMPLICATIONS FOR NURSING PRACTICE MI can be included during any of the patient visits to establish treatment collaboration with psychiatric patients at psychiatric facilities, outpatient clinics, and community mental health centers.
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Affiliation(s)
- Melike Yönder Ertem
- Department of Psychiatric Nursing, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Zekiye Çetinkaya Duman
- Department of Psychiatric Nursing, Nursing Faculty, Dokuz Eylül University, İzmir, Turkey
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Chakrabarti S. Treatment alliance and adherence in bipolar disorder. World J Psychiatry 2018; 8:114-124. [PMID: 30425942 PMCID: PMC6230924 DOI: 10.5498/wjp.v8.i5.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patient-centred care (PCC) and shared decision-making (SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder (BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow these principles and improve their interpersonal and communication skills in order to build productive alliances with their patients. This could go a long way in confronting the ubiquitous problem of non-adherence in BD. The role of future research in firmly establishing the alliance-adherence connection and uncovering the processes underlying this association will also be vital in devising effective ways to manage non-adherence in BD.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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31
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McCabe R, Healey PGT. Miscommunication in Doctor-Patient Communication. Top Cogn Sci 2018; 10:409-424. [PMID: 29749042 PMCID: PMC6033118 DOI: 10.1111/tops.12337] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/29/2018] [Accepted: 02/19/2018] [Indexed: 12/30/2022]
Abstract
The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA "repair" framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non-adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist-patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists' talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients' psychotic experiences increases psychiatrists' self-repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor-patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low-cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.
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Affiliation(s)
- Rose McCabe
- Institute of Health Research, University of Exeter Medical School
| | - Patrick G T Healey
- School of Electronic Engineering and Computer Science, Queen Mary University of London
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Pestana-Santos A, Loureiro L, Santos V, Carvalho I. Patients with schizophrenia assessing psychiatrists' communication skills. Psychiatry Res 2018; 269:13-20. [PMID: 30145294 DOI: 10.1016/j.psychres.2018.08.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 05/22/2018] [Accepted: 08/13/2018] [Indexed: 01/05/2023]
Abstract
Communication plays a central role in mental health care. Yet, studies fail to address the adequacy of psychiatrists' communication according to patients' needs. We examined how patients with schizophrenia assess their psychiatrists' communication skills, inspecting the importance that these aspects have for patients. Thirty patients with schizophrenia filled the Communication Assessment Tool after the appointment with their psychiatrists. An external observer also rated the videotaped appointments using the same instrument. Patients' mean rating of their psychiatrists' communication was 4.28 (mean proportion of excellent, "5" scores, was 57.4%). "Treated me with respect" received the highest mean, whereas "Encouraged me to ask questions" received the lowest. The assessment by the external observer was concordant, though lower (mean = 3.39) than patients'. Psychiatrists' communication skills correlated positively with the importance that patients gave to the respective communication aspects (overall mean importance = 2.77). Main discrepancies were related with "Understood my concerns" and "Involved me in decisions". Patients who were non-married, with higher education level and in medical treatment for less time gave significantly higher scores to psychiatrists' communication. Patients with schizophrenia consider clinical communication important and their psychiatrists' communication adequate. Room for improvement exists, namely regarding more elicitation of patients' health concerns and involvement in the encounter.
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Affiliation(s)
| | - Luís Loureiro
- Department of Research, Nursing School of Coimbra, Coimbra, Portugal
| | - Vítor Santos
- Department of Psychiatry, Coimbra University and Hospital Centre, Coimbra, Portugal
| | - Irene Carvalho
- Department of Medical Psychology, Faculty of Medicine of Oporto University, Oporto, Portugal
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Gunasekara I, Patterson S, Scott JG. 'What makes an excellent mental health doctor?' A response integrating the experiences and views of service users with critical reflections of psychiatrists. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1752-1762. [PMID: 28470745 DOI: 10.1111/hsc.12449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Abstract
While therapeutic relationships are appropriately recognised as the foundation of mental health service, service users commonly report suboptimal experiences. With shared understanding critical to improvement in practice, we explored service users' experiences and expectations of psychiatrists and consultations, engaging psychiatrists throughout the process. Using an iterative qualitative approach we co-produced a response to the question 'what makes an excellent mental health doctor?' Experiences and expectations of psychiatrists were explored in interviews with 22 service users. Data collection, analysis and interpretation were informed by consultation with peer workers. Findings were contextualised in formal consultations with psychiatrists. As 'masters of their craft', excellent mental health doctors engage authentically with service users as people (not diagnoses). They listen, validate experiences and empathise affectively and cognitively. They demonstrate phronesis, applying clinical knowledge compassionately. Psychiatrists share service users' aspiration of equitable partnership but competing demands and 'professional boundaries' constrain engagement. Consistent delivery of the person-centred, recovery-oriented care promoted by policy and sought by service users will require substantial revision of the structure and priorities of mental health services. The insights and experiences of service users must be integral to medical education, and systems must provide robust support to psychiatrists.
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Affiliation(s)
- Imani Gunasekara
- Metro North Mental Health, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Sue Patterson
- Metro North Mental Health, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - James G Scott
- Metro North Mental Health, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- The University of Queensland Centre for Clinical Research, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park, Wacol, Queensland, Australia
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Mallisham SL, Sherrod B. The Spirit and Intent of Motivational Interviewing. Perspect Psychiatr Care 2017; 53:226-233. [PMID: 27252143 DOI: 10.1111/ppc.12161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/29/2015] [Accepted: 02/03/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To describe an educational program to improve inpatient psychiatric nursing staff communication skills to better provide patient-centered care throughout patient hospitalization. DESIGN AND METHODS Delivered and evaluated an educational program to increase inpatient staff knowledge and use of communication skills during patient encounters. CONCLUSIONS Emphasizing the spirit and intent of motivational interviewing in a training program results in a translation of the newly obtained knowledge into nursing practice, as evidenced by observed use of motivational interviewing skills during which patient encounters to strengthen the therapeutic alliance. PRACTICE IMPLICATIONS Advanced Psychiatric Nurse Practitioners can provide an important role of coaching/mentorship for inpatient psychiatric nursing staff to further develop communication skills that are meaningful, patient-centered, and may lead to improved treatment adherence.
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Affiliation(s)
- Sandra L Mallisham
- Sandra L. Mallisham, DNP, PMHNP-BC, is a Psychiatric/Mental Health Nurse Practitioner, San Antonio Military Medical Center, San Antonio, Texas, USA; and
| | - Brad Sherrod
- Brad Sherrod, DNP, RN, is an Assistant Professor of Nursing, Chatham University, Pittsburgh, Pennsylvania, USA
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Dirik A, Sandhu S, Giacco D, Barrett K, Bennison G, Collinson S, Priebe S. Why involve families in acute mental healthcare? A collaborative conceptual review. BMJ Open 2017; 7:e017680. [PMID: 28963308 PMCID: PMC5623469 DOI: 10.1136/bmjopen-2017-017680] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Family involvement is strongly recommended in clinical guidelines but suffers from poor implementation. To explore this topic at a conceptual level, a multidisciplinary review team including academics, clinicians and individuals with lived experience undertook a review to explore the theoretical background of family involvement models in acute mental health treatment and how this relates to their delivery. DESIGN A conceptual review was undertaken, including a systematic search and narrative synthesis. Included family models were mapped onto the most commonly referenced underlying theories: the diathesis-stress model, systems theories and postmodern theories of mental health. Common components of the models were summarised and compared. Lastly, a thematic analysis was undertaken to explore the role of patients and families in the delivery of the approaches. SETTING General adult acute mental health treatment. RESULTS Six distinct family involvement models were identified: Calgary Family Assessment and Intervention Models, ERIC (Equipe Rapide d'Intervention de Crise), Family Psychoeducation Models, Family Systems Approach, Open Dialogue and the Somerset Model. Findings indicated that despite wide variation in the theoretical models underlying family involvement models, there were many commonalities in their components, such as a focus on communication, language use and joint decision-making. Thematic analysis of the role of patients and families identified several issues for implementation. This included potential harms that could emerge during delivery of the models, such as imposing linear 'patient-carer' relationships and the risk of perceived coercion. CONCLUSIONS We conclude that future staff training may benefit from discussing the chosen family involvement model within the context of other theories of mental health. This may help to clarify the underlying purpose of family involvement and address the diverse needs and world views of patients, families and professionals in acute settings.
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Affiliation(s)
- Aysegul Dirik
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Sima Sandhu
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Katherine Barrett
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Gerry Bennison
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Sue Collinson
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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36
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community PsychiatryWHO Collaborating Centre for Mental Health Services Development, Queen Mary University of LondonLondonUK
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37
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Priebe S, Ramjaun G, Strappelli N, Arcidiacono E, Aguglia E, Greenberg L. Do patients prefer optimistic or cautious psychiatrists? An experimental study with new and long-term patients. BMC Psychiatry 2017; 17:26. [PMID: 28095888 PMCID: PMC5240255 DOI: 10.1186/s12888-016-1182-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients seeking treatment may be assumed to prefer a psychiatrist who suggests a new treatment with confidence and optimism. Yet, this might not apply uniformly to all patients. In this study, we tested the hypothesis that new patients prefer psychiatrists who present treatments optimistically, whilst patients with longer-term experience of mental health care may rather prefer more cautious psychiatrists. METHODS In an experimental study, we produced video-clips of four psychiatrists, each suggesting a pharmacological and a psychological treatment once with optimism and once with caution. 100 'new' patients with less than 3 months experience of mental health care and 100 'long-term' patients with more than one year of experience were shown a random selection of one video-clip from each psychiatrist, always including an optimistic and a cautious suggestion of each treatment. Patients rated their preferences for psychiatrists on Likert type scales. Differences in subgroups with different age (18-40 vs. 41-65 years), gender, school leaving age (≤16 vs. >16 years), and diagnosis (ICD 10 F2 vs. others) were explored. RESULTS New patients preferred more optimistic treatment suggestions, whilst there was no preference among long-term patients. The interaction effect between preference for treatment presentations and experience of patients was significant (interaction p-value = 0.003). Findings in subgroups were similar. CONCLUSION In line with the hypothesis, psychiatrists should suggest treatments with optimism to patients with little experience of mental health care. However, this rule does not apply to longer-term patients, who may have experienced treatment failures in the past.
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Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, London, UK.
| | - Gonca Ramjaun
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, London, UK
| | - Nadia Strappelli
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, London, UK
| | - Eleonora Arcidiacono
- Università degli Studi di Catania, Azienda Ospedaliera-Universitaria "Policlinico-Vittorio Emanuele" Catania, Presidio "Gaspare Rodolico", U.O.P.I di Psichiatria Via Santa Sofia 78 9s 100, Catania, Italy
| | - Eugenio Aguglia
- Università degli Studi di Catania, Azienda Ospedaliera-Universitaria "Policlinico-Vittorio Emanuele" Catania, Presidio "Gaspare Rodolico", U.O.P.I di Psichiatria Via Santa Sofia 78 9s 100, Catania, Italy
| | - Lauren Greenberg
- Pragmatic Clinical Trials Unit (PCTU) Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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McCabe R, John P, Dooley J, Healey P, Cushing A, Kingdon D, Bremner S, Priebe S. Training to enhance psychiatrist communication with patients with psychosis (TEMPO): cluster randomised controlled trial. Br J Psychiatry 2016; 209:517-524. [PMID: 27445354 DOI: 10.1192/bjp.bp.115.179499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND A better therapeutic relationship predicts better outcomes. However, there is no trial-based evidence on how to improve therapeutic relationships in psychosis. AIMS To test the effectiveness of communication training for psychiatrists on improving shared understanding and the therapeutic relationship (trial registration: ISRCTN94846422). METHOD In a cluster randomised controlled trial in the UK, 21 psychiatrists were randomised. Ninety-seven (51% of those approached) out-patients with schizophrenia/schizoaffective disorder were recruited, and 64 (66% of the sample recruited at baseline) were followed up after 5 months. The intervention group received four group and one individualised session. The primary outcome, rated blind, was psychiatrist effort in establishing shared understanding (self-repair). Secondary outcome was the therapeutic relationship. RESULTS Psychiatrists receiving the intervention used 44% more self-repair than the control group (adjusted difference in means 6.4, 95% CI 1.46-11.33, P<0.011, a large effect) adjusting for baseline self-repair. Psychiatrists rated the therapeutic relationship more positively (adjusted difference in means 0.20, 95% CI 0.03-0.37, P = 0.022, a medium effect), as did patients (adjusted difference in means 0.21, 95% CI 0.01-0.41, P = 0.043, a medium effect). CONCLUSIONS Shared understanding can be successfully targeted in training and improves relationships in treating psychosis.
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Affiliation(s)
- Rose McCabe
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paula John
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jemima Dooley
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick Healey
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Annie Cushing
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David Kingdon
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephen Bremner
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Rose McCabe, PhD, University of Exeter Medical School, Exeter; Paula John, Dipl-Psych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; Jemima Dooley, BA, University of Exeter Medical School, Exeter; Patrick Healey, PhD, Cognitive Science Research Group, School of Electronic Engineering and Computer Science, Queen Mary University of London; Annie Cushing, PhD, Centre for Medical Education, Institute of Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, St Bartholomew's Hospital, London; David Kingdon, MD, Department of Psychiatry, University of Southampton, Southampton; Stephen Bremner, PhD, Stefan Priebe, FRCPsych, Newham Centre for Mental Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Information giving challenges and support strategies at the time of a mental health diagnosis: qualitative views from Australian health professionals. Soc Psychiatry Psychiatr Epidemiol 2016; 51:735-46. [PMID: 26880009 DOI: 10.1007/s00127-016-1187-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Communication of a mental health diagnosis can be a difficult process and is a poorly understood area of service provision. The aim of this qualitative study was to examine clinicians' perceptions of barriers and helpful strategies to discussing information about a mental health condition. METHOD Qualitative interviews with 19 Australian clinicians (general practitioners, mental health nurses, psychiatrists, and psychologists) working in several settings (community, hospital inpatient, outpatient, accident and emergency) and locations (urban, suburban and rural) were conducted and analysed thematically. RESULTS After theme saturation was reached, four primary themes relating to barriers and facilitators to communication at the time of diagnosis were identified in the data. Outside a recognised lack of focus on this area in training, themes included (1) engagement and timing of conversations; (2) stigma and its reduction; (3) perceived and desired knowledge for diagnostic information; and (4) working with distress. The synthesis of themes is demonstrated in a flowchart of suggestions for communicating news of mental health diagnosis that tracks the patient journey in receiving information from initial engagement to follow-up. CONCLUSIONS Talking with an individual about a mental health diagnosis is a non-linear, complex and changeable situation. However, health professionals report using specific strategies to aid this communication process, to meet the specific individual's needs. Strategies such as tailoring to the person's situation, utilising collaborative practice, effective coordination, and addressing stigma may be useful to inform clinician training and support whilst diagnosis remains a key feature of the mental health system in Australia.
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Omer S, Golden E, Priebe S. Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial. PLoS One 2016; 11:e0148415. [PMID: 26859388 PMCID: PMC4747516 DOI: 10.1371/journal.pone.0148415] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background DIALOG+ is a new intervention to make routine community mental health meetings therapeutically effective. It involves a structured assessment of patient concerns and a solution-focused approach to address them. In a randomised controlled trial, DIALOG+ was associated with better subjective quality of life and other outcomes in patients with psychosis, but it was not clear how this was achieved. This study explored the possible mechanisms. Methods This was a mixed-methods process evaluation within a cluster-randomised controlled trial. Focus groups and interviews were conducted with patients and clinicians who experienced DIALOG+ and were analysed using thematic analysis. The content of DIALOG+ sessions was recorded and analysed according to (i) the type of actions agreed during sessions and (ii) the domains discussed. The subjective quality of life measure was analysed with mixed-effects models to explore whether the effect of DIALOG+ was limited to life domains that had been addressed in sessions or consistent across all domains. Results Four qualitative themes emerged regarding the mechanisms of DIALOG+: (1) a comprehensive structure; (2) self-reflection; (3) therapeutic self-expression; and (4) empowerment. Patients took responsibility for the majority of actions agreed during sessions (65%). The treatment effect on subjective quality of life was largest for living situation (accommodation and people that the patient lives with) and mental health. Two of these domains were among the three most commonly discussed in DIALOG+ sessions (accommodation, mental health, and physical health). Conclusion DIALOG+ initiates positive, domain-specific change in the areas that are addressed in sessions. It provides a comprehensive and solution-focused structure to routine meetings, encourages self-reflection and expression, and empowers patients. Future research should strengthen and monitor these factors. Trial Registration ISRCTN Registry ISRCTN34757603.
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Affiliation(s)
- Serif Omer
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Eoin Golden
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, United Kingdom
- * E-mail:
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Sandhu S, Arcidiacono E, Aguglia E, Priebe S. Reciprocity in therapeutic relationships: A conceptual review. Int J Ment Health Nurs 2015; 24:460-70. [PMID: 26290469 DOI: 10.1111/inm.12160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reciprocity has generally been understood as a process of giving and taking, within an exchange of emotions or services, and has long been recognized as a central part of human life. However, an understanding of reciprocity in professional helping relationships has seldom received attention, despite movements in mental health care towards more collaborative approaches between service users and professionals. In this review, a systematic search of the published papers was conducted in order to explore how reciprocity is conceptualized and understood as part of the dyadic therapeutic relationship between professionals and service users. Eleven papers met our inclusion criteria and a narrative synthesis was used to synthesize the key concepts of reciprocity. The concepts of: 'dynamic equilibrium', 'shared affect', 'asymmetric alliance', and 'recognition as a fellow human being' were recurrent in understandings of reciprocity in professional contexts. These conceptualizations of reciprocity were also linked to specific behavioural and psychological processes. The findings suggest that reciprocity may be conceptualized and incorporated as a component of mental health care, with recurrent and observable processes which may be harnessed to promote positive outcomes for service users. To this end, we make recommendations for further research to progress and develop reciprocal processes in mental health care.
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Affiliation(s)
- Sima Sandhu
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Eleonora Arcidiacono
- Institute of Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Institute of Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Angell B, Bolden GB. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations. Soc Sci Med 2015; 138:44-56. [PMID: 26046726 PMCID: PMC4595152 DOI: 10.1016/j.socscimed.2015.04.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship.
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Affiliation(s)
- Beth Angell
- School of Social Work and the Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, United States.
| | - Galina B Bolden
- School of Communication and Information, Rutgers, the State University of New Jersey, United States
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Loughland C, Kelly B, Ditton-Phare P, Sandhu H, Vamos M, Outram S, Levin T. Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:160-164. [PMID: 25053274 DOI: 10.1007/s40596-014-0195-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 06/23/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Important gaps are observed in clinicians' communication with patients and families about psychiatric disorders such as schizophrenia. Communication skills can be taught, and models for education in these skills have been developed in other fields of medicine, such as oncology, providing a framework for training communication skills relevant to psychiatric practice. This study evaluated a pilot communication skills education program for psychiatry trainees, focusing on discussing schizophrenia diagnosis and prognosis. METHOD Communication skills training modules were developed based on an existing theoretical framework (ComSkil), adapted for discussing a schizophrenia diagnosis and prognosis. Pre-post training rating of self-reported confidence in a range of communication tasks was obtained, along with trainee views on the training methods. RESULTS Thirty-eight participants completed the training. Significant improvements in confidence were reported post training for discussing schizophrenia prognosis, including an increased capacity to critically evaluate their own communication skills. Participants reported high levels of satisfaction with the program. CONCLUSION This preliminary study provides support for the translation of a well-established educational model to psychiatric training addressing core clinical communication tasks and provides the foundation for the development of a more comprehensive evaluation and an extended curriculum regarding other aspects of care for patients with schizophrenia: ongoing management and recovery, dealing with conflict, and conducting a family interview.
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Outram S, Harris G, Kelly B, Cohen M, Bylund CL, Landa Y, Levin TT, Sandhu H, Vamos M, Loughland C. Contextual barriers to discussing a schizophrenia diagnosis with patients and families: need for leadership and teamwork training in psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:174-180. [PMID: 25398264 DOI: 10.1007/s40596-014-0226-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/18/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This research sought to gain insight into the processes used by clinicians to discuss a schizophrenia diagnosis with patients/families, with the aim of informing the development of a communications skills training program. METHODS A generic qualitative methodological approach was used. Sixteen mental health clinicians were recruited. Semi-structured individual interviews were used to explore their perceptions and experiences communicating a schizophrenia diagnosis. Interviews were recorded, transcribed, and thematic analysis undertaken. RESULTS There were five key themes relating to the process of communication about a diagnosis of schizophrenia: (1) orientation to patient care, (2) planning of communication, (3) the impact of team leadership and inter/intra-professional functioning on communication tasks, (4) the roles of different clinicians in communicating about diagnosis and treatment, and (5) time and resource deficiencies. Despite expressing care and concern for vulnerable patients and embracing the concept of multidisciplinary teams, communicating diagnostic information to patients and families was generally unplanned for, with little consistency regarding leadership approaches, or how the team communicated diagnostic information to the patient and family. This contributed to tensions between different team members. CONCLUSION The findings demonstrated a number of issues compromising good communication around a schizophrenia diagnosis, both in terms of clinician skill and clinical context, and support the importance of education and training for all members of the multidisciplinary team about their role in the communication process.
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Affiliation(s)
- Sue Outram
- University of Newcastle, Callaghan, Australia,
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Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach. Soc Psychiatry Psychiatr Epidemiol 2015; 50:363-70. [PMID: 25242154 DOI: 10.1007/s00127-014-0963-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/08/2014] [Indexed: 01/24/2023]
Abstract
PURPOSE The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year. METHODS Self-ratings of the HA by 588 people with severe mental illness who participated in a multicentre European study (CEDAR; ISRCTN75841675) were examined using latent class analysis. RESULTS Four main patterns of alliance were identified: (1) high and stable (HS, 45.6 %), (2) high and increasing (HI, 36.9 %), (3) high and decreasing (HD, 11.3 %) and (4) low and increasing (LI, 6.1 %). Predictors of class membership were duration of illness, ethnicity, and education, receipt of state benefits, recovery, and quality of life. CONCLUSIONS Results support findings from psychotherapy research about a predominantly stable course of the helping alliance in patients with severe mental illness over time. Implications for research and practice indicate to turn the attention to subgroups with noticeable courses.
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Outram S, Harris G, Kelly B, Bylund CL, Cohen M, Landa Y, Levin T, Sandhu H, Vamos M, Loughland C. 'We didn't have a clue': Family caregivers' experiences of the communication of a diagnosis of schizophrenia. Int J Soc Psychiatry 2015; 61:10-6. [PMID: 24869849 DOI: 10.1177/0020764014535751] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite widespread acceptance of the principle that patients should be informed about their diagnosis, many clinicians are reluctant to provide a diagnosis of schizophrenia. This study examines family caregivers' experiences of the communication of a schizophrenia diagnosis and related information. METHODS A generic qualitative methodological approach was used. In all, 13 family caregivers were recruited in regional New South Wales, Australia. Semi-structured interviews were used to explore their experiences and perceptions of discussing the diagnosis, prognosis and treatment of schizophrenia with mental health professionals. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken. RESULTS Family caregivers described long and difficult pathways to being given a diagnosis, haphazard means of finding out the diagnosis, high unmet needs for information, exclusion from the medical care process and problematic communication and general interactions with mental health clinicians. Caregivers were unanimous about the importance of receiving a timely diagnosis, for them and their relative with schizophrenia. CONCLUSION Family caregivers are an integral part of the mental health-care system, and they should be included early in discussions of diagnosis and treatment of a person with schizophrenia. Their perspectives on communicating a diagnosis of schizophrenia provide important information for communication skills training of psychiatrists and other mental health professionals.
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Affiliation(s)
- Sue Outram
- Discipline of Health Behaviour Sciences, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Gillian Harris
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Brian Kelly
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia
| | - Carma L Bylund
- Department of Medical Education, Hamad Medical Corporation, Dohar, Qatar
| | - Martin Cohen
- Hunter New England Mental Health, Waratah, NSW, Australia
| | - Yulia Landa
- Department of Psychiatry and Department of Public Health, Weill Cornell Medical College, New York, NY, USA
| | - Tomer Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Marina Vamos
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia
| | - Carmel Loughland
- Priority Research Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Hunter New England Mental Health, Waratah, NSW, Australia Schizophrenia Research Institute (SRI), Darlinghurst, NSW, Australia
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Giacco D, Luciano M, Del Vecchio V, Sampogna G, Slade M, Clarke E, Nagy M, Egerhazi A, Munk-Jørgensen P, Bording MFK, Kawohl W, Rössler W, Zentner N, Puschner B, Fiorillo A. Desire for information of people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1883-91. [PMID: 24907048 DOI: 10.1007/s00127-014-0901-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/26/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess (1) the desire of people with severe mental illness for information on their treatment and (2) whether the desire for information is associated with socio-demographic variables, diagnosis, illness duration, therapeutic relationship, needs and symptom severity. METHODS 588 outpatients with severe mental illness were recruited in six European countries (Germany, Denmark, Hungary, Italy, Switzerland, United Kingdom) during the "Clinical decision making and outcome in routine care of people with severe mental illness (CEDAR)" study (ISRCTN75841675). Desire for information was assessed by the Information subscale of the Clinical Decision Making Style Scale. Study participants with high desire for information were compared with those with moderate or low desire for information. RESULTS 80 % of study participants (n = 462) wanted to receive information on all aspects of their treatment (management, prognosis, alternative options for care). Participants with a high desire for information had less severe symptoms (OR = 0.988, CI = 0.977-1.000) and a better self-rated therapeutic alliance (OR = 1.304, CI = 1.130-1.508) with their clinician. CONCLUSIONS Most, but not all, people with severe mental illness have a high desire for information. Desire for information is associated with variables, such as therapeutic relationship and symptom severity, which are amenable to change during treatment.
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Affiliation(s)
- Domenico Giacco
- Department of Psychiatry, Second University of Naples, Largo Madonna delle Grazie, 80138, Naples, Italy,
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Del Piccolo L, Danzi O, Fattori N, Mazzi MA, Goss C. How psychiatrist's communication skills and patient's diagnosis affect emotions disclosure during first diagnostic consultations. PATIENT EDUCATION AND COUNSELING 2014; 96:151-158. [PMID: 24976629 DOI: 10.1016/j.pec.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/21/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe how emotions are disclosed during psychiatric diagnostic consultations and the contribution of the psychiatrists in facilitating their expression. METHODS Descriptive naturalistic study. Sixteen psychiatrists recorded their first consultations with 104 patients. Emotions and the immediate response given by the psychiatrist were coded with the Verona Coding Definitions of Emotional Sequences. For each disclosed emotion, the potential link to preceding expressions with affective content (cue or concern) was checked and the immediate response given by the psychiatrist was coded. RESULTS Most emotions were expressions of anxiety in terms of psycho-physiological or cognitive correlates. Concerns were present in 94% of the consultations, 47.6% were not linked to previous cues/concerns. Cues which became concerns and concerns which were further elaborated by the patient were those that had been acknowledged and handled by the psychiatrist by actively providing space to their expression. Compared to all other diagnostic groups, patients with mood disorders talked more explicitly and more often about their feelings. CONCLUSION The type and frequency of expressed emotions varies with patient diagnosis, suggesting different cognitive processes underlining psychopathology. PRACTICE IMPLICATIONS Psychiatrist's competence in providing space by using active listening skills is essential to uncover patients emotions.
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Affiliation(s)
- Lidia Del Piccolo
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
| | - Olivia Danzi
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Nives Fattori
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Claudia Goss
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
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Abstract
PURPOSE OF REVIEW There are complexities in communicating diagnostic information relating to schizophrenia spectrum disorders. There is a current dearth of research in understanding how clinicians effectively communicate with service users about such diagnostic news. In this review, we aim to synthesize the latest research throughout 2012 and 2013 that presented data relating to the communication of a diagnosis of schizophrenia spectrum disorders, including individuals who had experienced first-episode psychosis or were in at-risk mental states. Comprehensive database and manual searches were conducted which obtained data from both service users and health professional groups. RECENT FINDINGS Fourteen quantitative and qualitative studies were found. The majority of studies were descriptive and heterogeneous in content. Key themes included service user preferences towards disclosure and diagnostic terminology, health professional training, stigma-related issues and the use of diagnostic communication models. SUMMARY Overall, communication models that foster therapeutic relationships and actively encourage the health professional to reduce stigma may be a key to initial diagnostic discussions in clinical practice. Such communication models and intervention require further more rigorous evaluation, as none have been tested through randomized controlled protocols in clinical settings.
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