Barbara Stringer

User involvement in mental health care: the role of nurses. A literature review

This literature review was carried out to examine the effects of user involvement in shared decision-making processes and the methods/tools available to psychiatric nurses to measure and encourage user involvement. A systematic literature review was then used in this study. Many studies indicate that an increased involvement of service users leads to better care, better treatment compliance, improved health outcomes and higher levels of patient satisfaction. The tools and methods described are designed to measure the ability to participate, the process of implementation and the evaluation of healthcare services. An adequate instrument to measure user involvement will be necessary to underpin the positive effects. Although care providers have a statutory duty to help shape user involvement, and the tools required are available, care providers are still insufficiently inclined to take up this duty.

Recurrent suicide attempts in patients with depressive and anxiety disorders: The role of borderline personality traits

BACKGROUND The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. METHODS The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). RESULTS In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). LIMITATIONS The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. CONCLUSIONS Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patients coping skills with regard to anger.

Systematic review of self-management in patients with schizophrenia: psychometric assessment of tools, levels of self-management and associated factors.

AIMS The aim of this study was to provide an overview of existing knowledge about self-management assessment tools used in patients with schizophrenia, and levels of self-management and associated factors in these patients. BACKGROUND Self-management empowers patients with chronic conditions to manage their illness and psychosocial consequences. With respect to patients with schizophrenia, knowledge concerning self-management is scarce. A systematic review of existing literature focusing on self-management in these patients may contribute to further research programming and practice development. DESIGN A systematic review of the literature. DATA SOURCES A systematic literature search was conducted in March 2015 in Medline, Embase, PsycINFO and CINAHL. REVIEW METHODS Twelve articles were included. Data were extracted and categorized following the objectives of this review: (1) self-management assessment tools and their psychometric properties; (2) level of self-management; and (3) factors associated with self-management in patients with schizophrenia. RESULTS The PIH scale, the PAM-MH and the IMR scale were used to assess self-management. The overall psychometric quality of these instruments showed to be fair to poor. The level of self-management in patients with schizophrenia is comparable with other mental health conditions, higher than general population and lower than patients with physical health conditions. Several factors (e.g. sense of coherence, recovery and hope) were found to be associated. CONCLUSION Further efforts are needed to increase the methodological quality of psychometric research on self-management assessment tools. More insight in the level of self-management and associated factors may enhance the development of future interventions.

Collaborative Care for Patients With Severe Personality Disorders: Preliminary Results and Active Ingredients From a Pilot Study (Part I)

PURPOSE To test if a collaborative care program (CCP) with nurses in a coordinating position is beneficial for patients with severe personality disorders. DESIGN AND METHODS A pilot study with a comparative multiple case study design using mixed methods investigating active ingredients and preliminary results. FINDINGS Most patients, their informal caregivers, and nurses value (parts of) the CCP positively; preliminary results show a significant decrease in severity of borderline symptoms. PRACTICE IMPLICATIONS With the CCP, we may expand the supply of available treatments for patients with (severe) personality disorders, but a larger randomized controlled trial is warranted to confirm our preliminary results.

Collaborative Care for Patients With Severe Personality Disorders: Analyzing the Execution Process in a Pilot Study (Part II)

PURPOSE To examine the factors that influence the effective execution of a collaborative care program (CCP) for patients with severe personality disorders. DESIGN AND METHODS A multiple case study using qualitative research methods. FINDINGS Three factors were identified as influencing the execution process: (a) the context in which the CCP was executed, (b) the patient population, and (c) the individual application of the CCP by nurses. PRACTICE IMPLICATIONS The prominent position of mental health nurses in complex intervention programs such as CCPs poses new challenges for them in making these programs work. A CCP could be a useful intervention for patients with severe personality disorders because it offers the necessary structure in treatment.

Suïcidaliteit bij schizofrenie

SamenvattingVerpleegkundigen worden in hun werk met patiënten met schizofrenie regelmatig geconfronteerd met suïcidale gedachten, intenties en gedragingen van deze patiënten. Het omgaan hiermee ervaren verpleegkundigen vaak als erg moeilijk. Het stelt hen voor vele vragen en dilemmas. De richtlijn suïcidaliteit ondersteunt hen in de effectieve omgang met suïcidale patiënten met schizofrenie. Dit artikel beschrijft de wijze van ontwikkeling van de richtlijn, de inhoud van de richtlijn en de resultaten van een eerste pilotstudie.

Evaluation of an interaction-skills training for reducing the burden of family caregivers of patients with severe mental illness: a pre-posttest design

BackgroundFamily members who care for patients with severe mental illness experience emotional distress and report a higher incidence of mental illness than those in the general population. They report feeling inadequately prepared to provide the necessary practical and emotional support for these patients. The MAT training, an Interaction-Skills Training program (IST) for caregivers, was developed to meet those needs. This study used a single-arm pretest-posttest design to examine the impact of the training on caregivers’ sense of competence (self-efficacy) and burden.MethodsOne hundred family caregivers recruited from three mental health institutions participated in the training. Burden was assessed using the Involvement Evaluation Questionnaire, and self-efficacy using the Self-Efficacy Questionnaire. Analysis of variance with repeated measures was used to investigate whether participation in the training changed the level of family caregivers’ burden and self-efficacy. Pearson’s correlation was used to examine the relationships between self-efficacy and burden.ResultsOur results indicate that, after the training, self-efficacy increased significantly over time (p < 0.001) and that burden decreased significantly (p < 0.001). However, the results could not demonstrate the expected association between an increase of self-efficacy and decrease of burden. Caregivers expressed high appreciation for the training.ConclusionsAfter following the IST program, family caregivers of patients with severe mental illness experienced a greater sense of competence and a significant decrease in burden. The training was greatly appreciated and satisfied caregivers’ need to acquire the skills required in complex caregiving situations.Trial registrationThis study was retrospectively registered (14/01/2018) in the ISRCTN registry with study ID ISRCTN44495131.

Access to palliative care for homeless people: complex lives, complex care

BackgroundPeople experiencing homelessness often encounter progressive incurable somatic diseases in combination with psychiatric and psychosocial problems, and many need palliative care at the end of their lives. Little is known about how palliative care for this group can be started in good time and provided optimally. The objective of this paper is to give insight into the extent people experiencing homelessness have access to good palliative care.MethodsQualitative in-depth interviews were held to reconstruct the cases of 19 people experiencing homelessness in the Netherlands. Eight cases concerned persons being in the palliative phase (using the surprise question) and the other 11 cases concerned persons recently died after a period of ill health due to somatic illness. We used purposive sampling until data saturation was reached. The total number of interviews was 52. All interviews were transcribed verbatim and analysed inductively.ResultsThree key themes were: ‘late access’, ‘capricious trajectory’ and ‘complex care’. The first key theme refers to the often delayed start of palliative care, because of the difficulties in recognizing the need for palliative care, the ambivalence of people experiencing homelessness about accepting palliative care, and the lack of facilities with specific expertise in palliative care for them. The second key theme refers to the illness trajectory, which is often capricious because of the challenging behaviour of people experiencing homelessness, an unpredictable disease process and a system not being able to accommodate or meet their needs. The third key theme refers to the complexity of their care with regard to pain and symptom control, psychosocial and spiritual aspects, and the social network.ConclusionsThe care for in the palliative phase does not satisfy the core requirements of palliative care since there are bottlenecks regarding timely identification, the social network, and the assessment and management of physical symptoms and psychosocial and spiritual care needs. Education in palliative care of outreach professionals, training staff in shelters in the provision of palliative care, and building a network of palliative care specialists for people experiencing homelessness.

Nog veel winst te behalen

SamenvattingPalliatieve zorg voor mensen die dak- of thuisloos zijn, vereist een specifieke aanpak. Het NIVEL onderzocht negentien casussen, sprak met deskundigen en formuleerde een praktische handreiking.

In de frontlinie: wat hbo-professionals kunnen doen voor suïcidale patiënten in de ambulante zorg

Hbo-professionals zijn op veel plekken in de ambulante ggz werkzaam en in veel verschillende hoedanigheden. Verpleegkundigen , maatschappelijk werkenden en sociaalpedagogisch hulpverleners zijn vaak de eerst aangewezen professionals die de dagelijkse zorg aan patienten bieden. Anders opgeleide hbo-professionals, zoals creatief en psychomotorisch therapeuten, sociaaljuridisch hulpverleners en sommige maatschappelijk werkenden, hebben vaak specifiekere therapeutische taken voor een grotere groep patienten. Dit hoofdstuk is met name bedoeld voor die eerste groep professionals, die de dagelijkse begeleiding biedt en daarin ook te maken kan krijgen met suicidaal gedrag van patienten.