Minna Anttila

Developing an Internet-Based Support System for Adolescents with Depression

Background Depression is the most common mental health problem among adolescents. Despite policy guidance and governmental support to develop usable mental health services, there is still a lack of easily accessible and modern interventions available for adolescents in Finland’s majority official language. Objective Our objective was to develop a user-friendly and feasible Internet-based support system for adolescents with depression. Methods The Internet-based support system for adolescents with depression was developed. To create this new intervention, some examples of existing interventions were studied, the theoretical basis for the intervention was described, and the health needs of adolescents identified. As an outcome of the process, the results were combined and the content and delivery of a new intervention will be described here. Results Six individual weekly Internet-based support sessions were delivered by a tutor over a 6-week period of time and developed to form an intervention called Depis.Net. This was an Internet-based support system for adolescents with depression tailored to improve self-management skills and increase awareness of their own well-being and mental health. The intervention was accessible via an electronic platform, which was secured and password protected for users. The intervention on the Depis.Net website consisted of elements identifying adolescents’ needs, and offering self-monitoring, access to health information and self-reflective written exercises. An educated nurse tutor gave written feedback to each adolescent via the electronic platform. Conclusions An Internet-based support system for adolescents with depression was developed using a systematic approach with four steps. This was done to ensure that the intervention had a sound theoretical background and at the same time caters flexibly for the problems that adolescents commonly face in their daily lives. Its potential for adolescents visiting outpatient clinics will be evaluated in the next phase by means of a randomized controlled trial.

Team climate and attitudes toward information and communication technology among nurses on acute psychiatric wards

Objectives: To describe the association of team climate with attitudes toward information and communication technology among nursing staff working on acute psychiatric wards. Background: Implementation of ICT applications in nursing practice brings new operating models to work environments, which may affect experienced team climate on hospital wards. Method: Descriptive survey was used as a study design. Team climate was measured by the Finnish modification of the Team Climate Inventory, and attitudes toward ICT by Burkes’ questionnaire. The nursing staff (N = 181, n = 146) on nine acute psychiatric wards participated in the study. Results: It is not self-evident that experienced team climate associates with attitudes toward ICT, but there are some positive relationships between perceived team climate and ICT attitudes. The study showed that nurses’ motivation to use ICT had statistically significant connections with experienced team climate, participative safety (p = 0.021), support for innovation (p = 0.042) and task orientation (p = 0.042). Conclusion: The results suggest that asserting team climate and supporting innovative operations may lead to more positive attitudes toward ICT. It is, in particular, possible to influence nurses’ motivation to use ICT. More attention should be paid to psychosocial factors such as group education and co-operation at work when ICT applications are implemented in nursing.

Modification of an Internet-based patient education program for adults with schizophrenia spectrum disorder to suit adolescents with psychosis

Introduction: The overall goal of this study was to produce a user-friendly and high quality Internet-based patient education program for adolescents with psychosis. To achieve this, we ascertained the adolescents’ and health care professionals’ needs and expectations of patient education using Internet and the improvement proposals for an existing MentalNet program originally developed for adults with schizophrenia. Methods: The research process was conducted in two phases. First, adolescents’ and healthcare professionals’ needs for patient education and Internet were ascertained by interviewing adolescents and in two educational sessions with staff members (Phase I). Second, the preliminary evaluation of the Internet-based patient education program MentalNet was gathered from adolescents by an iterative process (see cyclic, recurring, repeating method), in one educational session with staff members and a questionnaire via email from other health care professionals (Phase II). Results: The needs and expectations of adolescents and health care professionals were related to the content, usability, design and realization of Internet-based patient education. Based on the information obtained the MentalNet program was modified to satisfy adolescents’ needs. Discussion: The usefulness and effectiveness of the program will require scrutiny in future studies.

Impact of moral sensitivity on moral distress among psychiatric nurses

Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses’ resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress.

Connectivity to computers and the Internet among patients with schizophrenia spectrum disorders: a cross-sectional study

Purpose Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). Patients and methods A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients’ medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. Results In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and >30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45–65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P<0.001), and younger people and those with higher education were associated with more active use. Conclusion Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.

Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services

BackgroundPeople admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients’ conditions, but also treatment environment and ward culture may affect patients’ behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods.MethodsThis is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff).DiscussionThe study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials.Trial registrationClinicalTrials.gov NCT02724748. Registered on 25th of April 2016.

Nurses’ experiences of the use of an Internet-based support system for adolescents with depressive disorders

ABSTRACT Background: Internet-based applications are potentially useful and effective interventions to reach and support adolescents with mental health problems. Adolescents’ commitment to the use of a new Internet-based intervention is closely related to the support they receive from healthcare professionals. This study describes nurses’ experiences of the use of an Internet-based support system for adolescents with depressive disorders. Method: Qualitative descriptive study design including individual interviews with nine nurses at two psychiatric outpatient clinics. The Technology Acceptance Model (TAM) was used as the theoretical background of the study. Results: Nurses described several benefits of using the Internet-based support system in the care of adolescents with depressive disorders if the nurses integrate it into daily nursing practices. As perceived disadvantages the nurses thought that an adolescent’s mental status might be a barrier to working with the support system. Perceived enablers could be organizational support, nurses’ attitudes, and technology-related factors. Nurses’ attitudes were identified as a barrier to supporting adolescents’ use of the Internet-based support system. Conclusion: The findings suggest that the implementation plan and support from the organization, including that from nurse managers, are crucial in the process of implementing a technology-based support system.

Social relationships among adolescents as described in an electronic diary: a mixed methods study

Social relationships among adolescents with mental disorders are demanding. Adolescents with depressive symptoms may have few relationships and have difficulties sharing their problems. Internet may offer reliable and easy to use tool to collect real-time information from adolescents. The aim of this study is to explore how adolescents describe their social relationships with an electronic diary. Mixed methods were used to obtain a broad picture of adolescents’ social relationships with the data gathered from network maps and reflective texts written in an electronic diary. Adolescents who visited an outpatient clinic and used an intervention (N=70) designed for adolescents with signs of depression were invited to use the electronic diary; 29 did so. The quantitative data gathered in the electronic diary were summarized with descriptive statistics, and the qualitative data were categorized using a thematic analysis with an inductive approach. We found that social relationships among adolescents with signs of depression can vary greatly in regards to the number of existing relationships (from lacking to 21) and the quality of the relationships (from trustful to difficult). However, the relationships may change, and the adolescents are also willing to build up their social relationships. Professionals need to be aware of the diversity of adolescents’ social relationships and their need for personalized support.

993 Nurses wellbeing – exposing factor to violent assaults by patients

Background Over 64% of nurses are exposed to violent assaults by patients worldwide. This creates costs for organisations and effect on nurses’ health. To prevent assaults, the causes should be known. It has been suggested, that patient characteristics explain only a proportion of assaults, while nurses’ wellbeing related factors might contribute to assaults. However, little is known about the specific wellbeing related factors exposing nurses to assaults. The objective of the abstract is to describe these factors exposing nurses to violent assaults by patients in healthcare. Methods Review of the literature with search terms violence, assaults, aggression, nurse and patient was conducted. Databases used were Cinahl, Pubmed, PsychInfo and Cochrane (2004–2015). Also manual searches were used. Studies were excluded if: they were conducted in other setting than healthcare, perpetrators were not patients or something else than quantitative research design was used. Searches resulted in 2368 citations, from which 14 studies met the inclusion criteria. Results Nurses’ anxiety, depression, fatigue, psychological distress, burn-out, stress and decreased psychological quality of life seem to expose them to assaults. Also nurses’ experiences of increased job demands, poor job control, job strain, time pressure, physical strain and excessive amount of work seem to be their exposing factor to violent assaults by patients. Further, nurses’ feelings of fear and guilt, as well as lowered job satisfaction might expose them to assaults. Conclusions Several wellbeing-related factors seem to expose nurses’ to violent assaults realised by patients. These are related to both psychological health and working conditions. Nurses’ psychological health and working conditions should be evaluated, monitored and supported as to reduce assaults towards them by patients. Longitudinal research is also needed to verify the results due to mainly cross-sectional nature of the studies.

Internet delivered question and answer column for patients with schizophrenia

The purpose of this study was to describe the use of an Internet delivered question and answer column among patients with schizophrenia. The column was developed for research purposes. The study sample consisted of patients (N = 100) admitted to acute inpatient psychiatric care in two hospital districts. Descriptive data were collected from the column to which a nurse replied within 3 days and analysed using qualitative content analysis. The column had four to five questions weekly. The most common age of users was 18–24 years, and the gender distribution was almost equal. Column use was heaviest among students (44%) and least among unemployed people (19%). Out of 85 questions or comments sent to the column, 25 (29%) were related to program training and the remaining 60 (71%) were related to medication (31%), illness and tests (25%), other questions or comments (9%), daily life and coping with it (4%), and places to receive treatment (2%). An Internet delivered question and answer column can be included in the care of patients with schizophrenia. However, it requires a new type of basic and additional education in the field of mental health care in order for nurses to be able to provide nursing via the Internet forum.