Maura Dowling

Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey

Recovery is the model of care presently advocated for mental health services internationally. The aim of this study was to examine the knowledge and attitudes of mental health professionals to the concept of recovery in mental health. A descriptive survey approach was adopted, and 153 health care professionals (nurses, doctors, social workers, occupational therapists and psychologists) completed an adapted version of the Recovery Knowledge Inventory. The respondents indicated their positive approach to the adoption of recovery as an approach to care in the delivery of mental health services. However, respondents were less comfortable in encouraging healthy risk taking with service users. This finding is important because therapeutic risk taking and hope are essential aspects in the creation of a care environment that promotes recovery. Respondents were also less familiar with the non-linearity of the recovery process and placed greater emphasis on symptom management and compliance with treatment. Multidisciplinary mental health care teams need to examine their attitudes and approach to a recovery model of care. The challenge for the present and into the future is to strive to equip professionals with the necessary skills in the form of information and training.

Advanced practice nursing: a concept analysis.

A variety of terms are used to describe advanced practice nursing roles internationally. This has resulted in confusion in terminology around these roles. The aim of this concept analysis was to clarify what is meant by advanced practice nursing internationally, what attributes signify advanced practice nursing and what are its antecedents, consequences, references and related terms. Rodgerss evolutionary method of concept analysis was used. Data sources included Medline, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Library, Science Direct, SCOPUS, Web of Science, Dissertation Abstracts and DARE as well as relevant nursing texts and professional organization websites. The analysis reveals that there are many different articulations of the advanced practice nursing role outlined in the literature. This variety in terminology hinders developments in advanced practice nursing roles. Consensus on advanced practice nursing definitions, terminology, educational requirements and regulatory approaches is integral to the implementation of the advanced practice nursing role internationally.A variety of terms are used to describe advanced practice nursing roles internationally. This has resulted in confusion in terminology around these roles. The aim of this concept analysis was to clarify what is meant by advanced practice nursing internationally, what attributes signify advanced practice nursing and what are its antecedents, consequences, references and related terms. Rodgerss evolutionary method of concept analysis was used. Data sources included Medline, CINAHL, Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Library, Science Direct, SCOPUS, Web of Science, Dissertation Abstracts and DARE as well as relevant nursing texts and professional organization websites. The analysis reveals that there are many different articulations of the advanced practice nursing role outlined in the literature. This variety in terminology hinders developments in advanced practice nursing roles. Consensus on advanced practice nursing definitions, terminology, educational requirements and regulatory approaches is integral to the implementation of the advanced practice nursing role internationally.

The unmet palliative care needs of those dying with dementia

An estimated 33.9 million people are living with dementia worldwide. The overall estimated median survival time from onset of dementia to death is 4.1 years for men and 4.6 years for women, with longer survival times in those with early-onset dementia. Much has been discussed about the needs of this vulnerable group of people particularly in terms of their health-care and end-of-life care (EoLC) needs. However, the literature suggests that people with end-stage dementia are still not receiving adequate or appropriate EoLC. Difficulty diagnosing dementia, a stigma surrounding the disease, lack of education of the dementia disease process and the ability to identify complications encountered at end-stage dementia by health-care providers, families and carers are some of the factors preventing those with dementia receiving effective EoLC. Great strides have been made to improve dementia palliative care; however, this cohort of patients still receive fewer referrals to appropriate palliative care services than other terminally ill patients.

A concept analysis of empowerment in chronic illness from the perspective of the nurse and the client living with chronic obstructive pulmonary disease

dowling m, murphy k, cooney a & casey d (2011)Journal of Nursing and Healthcare of Chronic Illness3, 476–487 A concept analysis of empowerment in chronic illness from the perspective of the nurse and the client living with chronic obstructive pulmonary disease Aims.  To explicate a model of empowerment appropriate to clients living with a chronic illness, in particular chronic obstructive pulmonary disease. Background.  Empowerment is a concept central to nursing practice and is viewed from a variety of perspectives in nursing literature. Empowerment shapes how those living with a chronic illness view their illness and approach their involvement in self-care. This concept analysis was conducted as part of the literature review to inform the development of the Pulmonary Rehabilitation in Nurse-led Community Environments trial. Design.  Review of the literature on empowerment, with particular focus on empowerment in chronic illness. Methods.  A search of electronic databases to March 2010 for literature related to ‘empowerment’ was conducted. Papers included in the review had reference to ‘empowerment’ in the abstract. The literature was then organised following guidance on the structure for concept analysis proposed by Norris (1982, Concept Clarification in Nursing) and Rodgers (Journal of Advanced Nursing, 1989). Results.  Empowerment in chronic illness is a process with both the nurse and client contributing to its evolvement. The nurse must feel empowered, communicate effectively and surrender control in the empowerment process. The client must be motivated to change and possess specific competencies to engage in the empowerment process. Both the nurse and client experience a transformation when empowered. Conclusion.  Despite identification of the characteristics, antecedents and consequences of empowerment in chronic illness, empowerment remains an evolving concept, with evident immaturity revealed in its competing definitions. Relevance to clinical practice.  This concept analysis provides nurses with an understanding of what patient attributes contribute to empowerment in chronic illness and how nurses on an individual level can influence the empowerment process for patients, through effective communication, surrendering control and focusing on goals.

Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service.

This audit reviewed current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. A sample of 60 case files, care plans and prescriptions were audited, which is 31% of the total number of service users receiving depot injections in the mental health service region (n= 181). The sample audited had a range of diagnoses, including: schizophrenia, schizoaffective disorder, bipolar affective disorder, depression, alcoholic hallucinosis and autism. The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only five (8%) case notes examined had documentation recorded describing the condition of the injection site, and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded. In 57 (95%) of case notes, no documentation of recorded information on the depot and on side effects was given. The failure to monitor and record some blood tests was partly attributed to a lack of clarity regarding whose responsibility it was. A standardized checklist has been developed as a result of the audit and this will be introduced by all teams across the service.

Home administration of bortezomib: Making a difference to myeloma patients' lives

IntroductionMultiple myeloma is a clonal malignancy of plasma cells, char-acterized by anaemia, renal dysfunction, lytic bone lesions and thepresence of excess monoclonal immunoglobulin. It is the secondmost common hematological disorder (Devenney and Erickson,2004). It remains a complex disease to diagnose and treat.However, our understanding of the biology of myeloma continuesto develop, and hence a number of new potential therapies havebeen identified, with improved outcomes and survival (Kumaret al., 2008).The introduction of novel agents, such as immunomodulatorydrugsorproteasomeinhibitors,eitheraloneorincombinationwithtraditional agents for the treatment of myeloma has led to a majorimprovement in patient outcomes, including survival, in the pastdecade. Based on significant improvements in response rates andoverallsurvival in elderlypatients when combined with melphalanin elderly patients (San Miguel et al., 2008), Bortezomib, a protea-someinhibitor,isnowlicensedasfrontlinetreatmentformyeloma.Bortezomib combined with dexamethasone has also proven to bea very effective induction therapy in younger patients prior toautologous stem cell transplant (Harousseau et al., 2006) and isnow viewed by some as the new standard for initial therapy ofyounger patients. Younger patients are those less than 65 years ofage and eligible for stem cell transplant. However, they must alsohave good performance status and without other co-morbidities.Initiatives in the home administration of chemotherapy areevident internationally (e.g. Lashlee and O’Hanlon Curry, 2007).With regard to the home administration of bortezomib, a pilotfeasibilityprojectofhomeadministrationofbortezomibtopatientswith myeloma has recently been reported from BournmouthHospital in England (McCarthy et al., 2009). However, that pilotprogram only included patients with relapsed disease and patientshadtolivewithina12 mileradiusofthehospital.Inaddition,Day1and Day 4 doses were administered in the hospital, and bloodsamples were taken on each visit. Three of our patient group werenewly diagnosed, receiving initial treatment for their myeloma.Furthermore, all patients on our program received first doses ofbortezomib safely at home. In addition, bloods on our program areonly taken on Day 8; the platelet nadir is day 11 so checking on day8 detects any significant drop prior to this. Finally, our patients liveas far away as 100 miles from the hospital.Why the initiative was startedGalway University Hospital (GUH) is a regional Irish hospitalserving a local urban and widely dispersed rural population. Giventhe emerging data supporting its use in all categories of patientswith multiple myeloma, there has been a major increase in the useofbortezomibastreatmentofmultiplemyelomapatientsattendingGUH. Since bortezomib requires frequent intravenous administra-tion(usuallytwiceaweek,fortwoconsecutiveweekswitha10dayrest period) this has impacted significantly on the hospital’s hae-matology day unit facility, which has severe capacity issues. Theadministration of bortezomib only takes ten seconds. However,

Understanding the Key Tenets of Heidegger’s Philosophy for Interpretive Phenomenological Research:

Martin Heidegger’s phenomenology provides methodological guidance for qualitative researchers seeking to explicate the lived experience of study participants. However, most phenomenological researchers apply his philosophy loosely. This is not surprising because Heidegger’s phenomenological philosophy is challenging and the influence of his philosophy in shaping the conduct of interpretive phenomenological research is broadly debated. This article presents an exploration of Dasein, a key tenet of Martin Heidegger’s interpretive phenomenology and explicates its usefulness for phenomenological research. From this perspective, we present guidance for researchers planning to utilize Heidegger’s philosophy underpinning their research.

Multiple myeloma: managing a complex blood cancer

This article gives a comprehensive overview of multiple myeloma (MM), a complex blood cancer involving overproduction of plasma cells. Although MM remains incurable, patients are living longer as a result of multiple treatment options. However, MM patients are also living with a higher symptom burden. The overall aims in managing MM are therefore to control disease progression, prolong survival and improve quality of life.

Nurses’ experience of loss on the death of older persons in long‐term residential care: findings from an interpretative phenomenological study

Background.  Little is known of the experience of loss among nurses working with older persons in long-stay settings. Objectives.  The aim of this study was to explore and describe the experience of loss among nurses working in a long-term residential care setting. Design.  Interpretative Phenomenological Analysis (IPA) was the method adopted. Data was collected by semi-structured interviews undertaken with seven nurses. Results.  The findings revealed three main themes: ‘life’s final journey’, ‘family’ and ‘professional carer’. Conclusions.  The experience of loss on the death of an older person is described by nurses in the context of the care they give at end of life, and the relationships nurses developed with the older person’s family. Where the older person has no contact with family, nurses become the ‘family’ and this contributed to the feeling of loss experienced. Finally, the loss experienced by nurses when an older person dies suddenly can often be emotive. Relevance to clinical practice.  Supporting nurses in their provision of end-of-life care to older persons is essential. Nurses’ attempts to keep memories of deceased residents alive by remembrance, helps place loss in the context of acknowledgment of the person’s life.

Evaluation of bone marrow examinations performed by an advanced nurse practitioner: an extended role within a haematology service.

PURPOSE Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre. METHODS The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007-September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP. A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist. RESULTS All 30 BM examinations undertaken by the ANP were sufficient for diagnosis. CONCLUSIONS The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis.