Nicole Ricard

Longitudinal effects of an early family intervention programme on the adaptation of parents of children with a disability

This study assesses the longitudinal effects of an original early intervention programme on the adaptation of parents of children with a disability (Down syndrome and cleft lip/palate, i.e. DS and CLP). Variations in the effects of the programme according to the time of measurement, the type of disability and parents gender are also examined. Globally, the results show a better adaptation among parents who participated in the intervention programme compared to those who did not participated in the programme. These parents had lower levels of parental stress, they had more positive perceptions and attitudes concerning their childs disability and their parental situation, they were more confident in their own resources and the help they could receive from others, they had lower levels of emotional distress, anxiety and depression and they perceived more emotional support from their spouse. In general, these gains were maintained throughout the year when the children were between six and 18 months of age, they were relatively similar for parents of children with DS and parents of children with CLP, as well as for mothers and fathers.

Factor structure of the Multnomah Community Ability Scale.

More and more, Intensive Community Treatment programs in Canada use questionnaires to evaluate the health and social functioning of individuals suffering from a severe mental illness. However, seldom are these tools subject to psychometric analyses to establish their validity on independent samples. This article presents the results of the validation of the French version of the Multnomah Community Ability Scale. Confirmatory factor analyses were carried out to assess the factorial structure. The factor structure, four dimensions with three items, emerging from a first sample was replicated with data from a different sample of clients. Moreover, these four dimensions respect the initial factor solution of the Multnomah Community Ability Scale, which are a) interference with functioning, b) adjustment to living, c) social competence, and d) behavior problems. The study shows the structural validity of this brief questionnaire, which could be useful both for clinical and research settings to evaluate the effectiveness of interventions.

Developing a model of recovery in mental health

BackgroundThe recovery process is characterized by the interaction of a set of individual, environmental and organizational conditions common to different people suffering with a mental health problem. The fact that most of the studies have been working with schizophrenic patients we cannot extend what has been learned about the process of recovery to other types of mental problem. In the meantime, the prevalence of anxiety, affective and borderline personality disorders continues to increase, imposing a significant socioeconomic burden on the Canadian healthcare system and on the patients, their family and significant other [1]. The aim of this study is to put forward a theoretical model of the recovery process for people with mental health problem schizophrenic, affective, anxiety and borderline personality disorders, family members and a significant care provider.Method and designTo operationalize the study, a qualitative, inductive design was chosen. Qualitative research open the way to learning – the inside – about different perspectives and issues people face in their process of recovery. The study proposal is involving a multisite study that will be conducted in three different cities of the Province of Québec in Canada: Montréal, Québec and Trois-Rivières. The plan is to select 108 participants, divided into four comparison groups representing four types of mental health problem. Each comparison group (n = 27) will be made up of 9 units. Each unit will comprise one person with a mental health problem (schizophrenia, affective anxiety, and borderline personality disorders. Data will be collected through semi-structured open-ended interview. The in-depth qualitative analysis inspired from the grounded theory approach will permit the illustration of the recovery process.DiscussionThe transformation of our Health Care System and the importance being put on the people well-being and autonomy development of the person who are suffering with mental problem This study protocol follows-up on earlier theory-building process that begun with the work of Noiseux [2]. The contribution of the present study is to increase the comprehension of the concept of recovery and to enhance the body of knowledge in that domain. Very few studies have examined recovery and the one that did used a descriptive approach which did not take into account the perspective of the family members and the caregivers of the recovery process.

Empirical Verification of a Theoretical Model Derived From the Roy Adaptation Model: Findings From Five Studies

This article presents a theoretical model derived from the Roy adaptation model and the findings of an empirical verification of this model from five studies. Four groups of subjects were included in the studies: informal caregivers of demented relatives at home, informal caregivers of psychiatrically ill relatives at home, professional caregivers of elderly institutionalized patients, and aged spouses in the community. In at least three studies, a number of theoretical propositions derived from the Roy adaptation model were supported using LISREL VIII, thus adding credence to some tenets of Roys model. Particularly, the focal stimulus of perceived stress, the contextual stimulus of conflicts in the exchange of social support, and one component of the coping mechanisms (the passive/avoidance coping strategies) were positively linked directly or indirectly with psychological distress, which is an indicator of adaptation in the self-concept mode. Given their importance, these elements should be considered in the development of a middle-range theory of psychological adaptation derived from the Roy adaptation model.

Intrusion errors in explicit memory: Their differential relationship with clinical and social outcome in chronic schizophrenia

Introduction. Memory deficits might account for clinical and adaptive differences between groups of patients with chronic schizophrenia. We investigated the qualitative factors of memory that influence clinical and social status. Methods. Psychosocial functioning, clinical symptoms, and memory function were assessed in 99 patients at four time points over a 16-month period using recall scores for semantically related words, unrelated words, paired associated learning, and word span. An initial cluster analysis using symptom assessment data from all four time points divided the sample into three groups: patients with low symptoms ratings that remained stable throughout the study period (low symptom-stable group—LSSG; N=51); patients with initially high symptoms ratings that subsequently improved (high symptom-improved group—HSIG; N=32); and patients with initially high symptoms ratings that deteriorated during the follow-up (high symptom-deteriorated group—HSDG; N=16). Results. Memory was better preserved in LSSG compared to HSIG and HSDG patients. Recall performance was generally better for semantically related words than for unrelated words but the difference between LSSG and the two other groups was more constant over time for semantically related words. Extra-list errors variable was positively correlated with three PANSS measures (r=.25−.47). Also, the extra-list errors scores were correlated with the Magical Ideation Scale (r=.34–.39). Memory scores (global explicit, unrelated, related) were significantly and positively correlated with independent living skills (r=.26–.55) and the extra-list errors were negatively correlated with both social support and independent living skills (r=−.29 and r=−.46, respectively). All groups showed a reduction in extraneous false recognition errors/intrusions (FRIs) over time with the HSIG showing the greater change. HSIG and HSDG patients committed slightly more FRIs in recall tasks (extraneous information) than LSSG patients. Conclusion. Memory performance is better in patients presenting with less severe symptomatology. The extent to which FRIs reduce over time in patients with schizophrenia is a novel finding.

Empirical Testing of a Longitudinal Model Derived from the Roy Adaptation Model

This article presents the steps and results of the empirical testing of a theoretical longitudinal model, derived from Roys nursing conceptual model, of the psychosocial determinants of adaptation in different target groups. The model was elaborated and empirically verified based on the integrated results of four longitudinal studies involving groups vulnerable to mental health problems. By means of structural equation analyses, the cross-sectional model was verified at two points in time. The results showed that the model was relatively stable over time. The model was also tested using longitudinal data. Results showed little consistency in the patterns of relationships across studies. The significant links that emerged from the analyses shed some light on the complexity of the process of adaptation to different types of stressors. They underscore the importance for nursing practice to develop interventions aimed at certain variables: perceived stress, conflicts in the exchange of support, and passive and avoidance coping strategies. The results also highlight the importance of the relationship between perceived stress, passive/avoidance coping strategies and psychological distress.

Enfermería de práctica avanzada: un tesoro oculto

Resumen A traves del mundo entero, los logros de las enfermeras de practica avanzada son numerosos y remarcables. Sin embargo, llegado el tiempo de tomar decisiones en el ambito de las politicas de salud y de las transformaciones del sistema, se nos deja de lado. La ambiguedad sobre la esencia de la enfermeria de practica avanzada y las poco desarrolladas habilidades politicas de las enfermeras pueden ser dos de los factores contribuyentes. Las enfermeras debemos detenernos y pensar sobre estos aspectos con vistas al futuro de la enfermeria de practica avanzada y a la posicion de la profesion dentro del Sistema Canadiense de Salud. Esta reflexion debe tener lugar en un nivel mas elevado al de la discusion sobre titulos, roles, funciones y tareas. En la vanguardia, el desarrollo de un fuerte liderazgo, la adquisicion de poder colectivo, la busqueda de la cohesion dentro de la profesion y un profundo compromiso con el avance de la disciplina son obligaciones para las enfermeras comprometidas con la enfermeria de practica avanzada. Es tiempo de sacar a la luz los logros de las enfermeras de practica avanzada y de demostrar la verdadera valia de nuestras habilidades. Despues de todo, ello iria encaminado al beneficio de una sociedad mas saludable y de un sistema mas eficiente de salud, ya uno de los mejores en el mundo. Que ya habiamos jugado un papel en ello es incuestionable.

Building life around foster home versus moving on: the competing needs of people living in foster homes.

OBJECTIVE This article reports findings on the competing needs of people living in psychiatric foster homes in Montreal, Canada. METHODS Semi-structured interviews were conducted with 33 residents. Consumers describe the tensions associated with foster home life. RESULTS Two overall competing needs emerged: the need to build their lives around the foster home and the need to build life beyond the foster home. Residents describe their need for security and support versus their need for greater personal autonomy, the dilemmas associated with communal living, and their struggle to envisage a positive future. CONCLUSIONS These findings have important implications for mental health professionals mandated to dismantle foster homes for more autonomous housing.

Development and validation of the RQC: a daily contact log for ACT and ICM teams.

AIM Instruments to measure the process--the daily activities of home care workers--have received little attention and may impede research in refining the active ingredients, the clientele best served and continuous quality improvement. We developed a decade ago in Quebec, Canada, a new daily contact log (relevé quotidien des contacts or RQC) that has now reached in practice 1 million entries. METHODS Three features distinguish the RQC development, namely, practical ergonomics, a clear logic, and response categories easy to understand and retain. The instrument is filled following any 10-minute or more contact with or about the client, and covers the location, time and actors of the episode of care, and the nature of the intervention (crisis, representing, accompanying, discussing) in 10 areas (i.e. medication, daily living activities, housing, relationships, substance abuse, legal, etc.). Inter-rater agreement for each RQC response category and rater agreement with a criterion measure (coded vignettes) were evaluated. RESULTS Kappa coefficients and intra-class correlation coefficients yielded results ranging from at least moderate to generally substantial agreement for all 77 response categories. CONCLUSIONS The new RQC may support international studies of the implementation and application of various forms of intensive home care, refining its indications, and serves as a clinical and managerial tool to ensure quality of the interventions.