Phyllis Montgomery

What’s so big about the ‘little things’: A phenomenological inquiry into the meaning of spiritual care in dementia

Although it is widely accepted that spirituality is an important aspect of health and healing in long term care, its meaning and day-to-day implications remain poorly understood. This study explored the meaning of spiritual care from the perspectives of patients living with moderate to severe dementia, their families and their care providers. Using a hermeneutic phenomenological approach, open-ended interviews were conducted in a dementia care unit with 29 participants, including patients, families, RNs, LPNs, and hospital chaplains. Interviewees were asked to share their stories and insights about spiritual care in dementia. Using hermeneutic analysis, the central theme of ‘little things’ was identified. Recognition and attendance to ‘little things’ promoted patients’ sense of personhood and connectedness to self and others. Barriers to spiritual care in dementia were also identified. These findings inform our understanding about effective relational approaches in spiritual care with this unique population.

Evidence-Based Recommendations for Depressive Symptoms in Postpartum Women

Postpartum depression is a serious health issue affecting 13% of women from diverse cultures. Despite the well-documented consequences of postpartum depression, it remains difficult to identify, and diverse practices relate to its prevention and treatment. Evidence-based interventions are essential to improve both maternal and infant health outcomes associated with pregnancy. This article describes the development process of an evidence-based practice guideline for postpartum depression and highlights the practice recommendations related to the confirmation, prevention, and treatment of depressive symptoms in postpartum mothers.

The Experience of Gatekeeping: A Psychiatric Nurse in an Emergency Department

Emergency departments are increasingly identified as the entry point to mental health services. In the hope of facilitating the flow of psychiatric patients through a general hospitals emergency department, experienced psychiatric nurses were asked to participate in a pilot project in a general hospital in Canada. This paper is a reflection of one emergency psychiatric nurses (EPN) experience of her role being transformed into that of a gatekeeper. The notion of “gatekeeper” as a metaphor highlights “keeping psychiatric patients out” of an already strained emergency system. As a means to balance fiscal demands with patient care, the EPN inadvertently served to obscure entry for patients with mental illness who were seeking emergency services.

Supported housing programs for persons with serious mental illness in rural northern communities: A mixed method evaluation

BackgroundDuring the past two decades, consumers, providers and policy makers have recognized the role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able to live independently in the community. Much of supported housing research to date, however, has been conducted in large urban centers rather than northern and rural communities. Northern conditional and contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing housing markets, lack of a continuum of support or housing services, and in some communities, a poor quality of housing challenge the viability of effective supported housing services. The current research proposal aims to describe and evaluate the processes and outcomes of supported housing programs for persons living with SMI in northern and rural communities from the perspective of clients, their families, and community providers.MethodsThis research will use a mixed method design guided by participatory action research. The study will be conducted over two years, in four stages. Stage I will involve setting up the research in each of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information about the three client outcomes: housing history, quality of life and housing preference. In Stage III two participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of supported housing services. In the last stage findings from the study will be re-presented to the participants, as well as other key community individuals in order to translate them into policy.ConclusionSupported housing intervention is a core feature of mental health care, and it requires evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data collection approaches, contributes to a comprehensive, systems-level examination of supported housing in smaller communities. It is anticipated that the studys findings will not only have utility across Ontario, but also Canada.

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology.

BackgroundNursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.MethodsQ methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.ResultsA total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site.ConclusionsSenior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.

A comparison of individual and social vulnerabilities, health, and quality of life among Canadian women with mental diagnoses and young children.

PURPOSE this study examined whether differences exist among women with mental health issues who had either young, adult, or no children in relation to their individual and social vulnerabilities, health, and quality of life. METHODS the design of this study was a secondary quantitative analysis of data extracted from a larger Canadian 5-year study focused on mental health and housing. This studys sample included 234 female psychiatric consumer/survivors: 108 (46%) women reported having no children, 68 (29%) had at least one child younger than 18 years of age, and 58 (25%) had children 18 years of age or older. The women completed structured interviews between 2004 and 2006. FINDINGS seventy-nine percent of mothers were separated from their young children. In comparison with women with older children and those without children, women with young children were more often homeless, had fewer strengths/resources, greater physical but lower cognitive/intellectual functioning, and a low perception of quality of life regarding their financial situation. In addition, women with young children reported the greatest problem with substance use and poorest quality of life regarding daily activities, health, and overall quality of life. These results, however, were mediated by the confounding effects of housing. No differences were identified between groups regarding utilization of health and social services. CONCLUSION these findings support the need for early integrated health and social interventions that assist women achieve their well-being.

Patient health outcomes in psychiatric mental health nursing

This integrative literature review examined evidence concerning the relationship between psychiatric mental health nursing interventions and patient-focused outcomes. Empirical studies, published between 1997 and 2007, were identified and gathered by searching relevant databases and specific data sources. Although 156 articles were critically appraised, only 25 of them met the inclusion criteria. Findings from this review showed that the most frequently used outcome instruments assessed psychiatric symptom severity. Most of the instruments targeted two symptom categories: altered thoughts/perceptions and altered mood. Other outcome instruments were categorized in the following domains: self-care, functioning, quality of life and satisfaction. The most important finding of this review is the lack of consistently strong evidence to support decisions concerning which outcome instrument or combination of instruments to recommend for routine use in practice. Based on this review, additional research to conceptualize, measure and examine the feasibility of outcome instruments sensitive to psychiatric mental health nursing interventions is recommended.

Social Determinants of Health and Health Outcomes in Men and Fathers with Mental Health Issues

The purpose of the study was to examine whether differences exist in social determinants of health and health outcomes between men without children and two groups of fathers: fathers with children less than 18 years of age and fathers with children 18 years of age or older. The design of the study was a secondary analysis of quantitative data extracted from a larger provincially funded five year research project focused on mental health and housing. The sample included 277 Canadian male psychiatric consumers: 99 (36%) were fathers, 63 (65%) had younger children, and 34 (35%) had adult children. Age, marital status, employment, housing, income, legal involvement, and social support were used as a proxy for social determinants of health. The three health outcome measures were quality of life, severity of problems, and functioning. The descriptive and comparison analysis showed that although half of the fathers of younger children expressed a preference to parent, only two were parenting on a day-to-day basis. Compared with non-fathers, fathers were characteristically older, separated, unemployed, and homeless. Fathers reported poorer satisfaction with family relationships and greater struggles with substance misuse. Fathers of younger children had a higher rate of overall problem severity than fathers of adult children. Overall, fathers with mental illness in despairing social conditions had poorer health outcomes and may require specialized supports to minimize the barriers to fulfill their desired role to parent.

Exploring Differences Between Community-Based Women and Men with a History of Mental Illness

Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore genders effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of functioning, personal strengths and resources, and illness severity. Results of the secondary analysis found male and female differences that corroborated previous research. More women are housed than men, more women with mental illness were coupled than men, men have fewer social supports, and men have more substance abuse issues than women. These findings suggest health services within the community must consider these sex differences if they wish to properly assist Canadian individuals diagnosed with mental illnesses.

Homelessness, a State of Mind?: A Discourse Analysis

This article presents a discourse analysis of a womans written account of mental illness and homelessness. In her preparation as a co-presenter at a conference for decision- and policy-makers, Anna wrote eight distinct drafts of her speaking notes; each time emphasizing different aspects of her experiences with mental illness and homelessness. By sharing her preparatory writings, Anna offers a rare insight into the ‘evolution’ of the thinking that went into representing her story to an audience of professionals. In addition, this analysis represents an interpretation and alternative forum to learn from Annas story.