Sue McAndrew

Minding our own bodies: Reviewing the literature regarding the perceptions of service users diagnosed with serious mental illness on barriers to accessing physical health care

International studies consistently demonstrate that individuals diagnosed with severe mental illness (SMI) have an increased risk of co-morbid physical health problems and premature death. During the past decade, government policy in the UK has focused on improving the physical health of those with SMI. Despite this, international research has continued to report barriers to accessing appropriate services. These have been identified as emanating from service users and professionals alike, and also from institutional bureaucracy. Most of this research has reported difficulties from the perspective of various professional groups, with little attention being paid to the service user voice. Studies from the service user perspective undertaken in the past 10 years equate to six qualitative and three quantitative studies, and it appears that poor physical health care remains a problem in the developed world. The quality of this care is compromised by practical problems and interpersonal difficulties between service users and health-care providers and between providers of mental health services and those providing physical health care. This paper presents a review of the nine international studies and discusses the implications for developing policy and practices that could lead to improved physical health-care services for people experiencing SMI.

Minding our own bodies : reviewing the literature regarding the perceptions of service users diagnosed with SMI on barriers to accessing physical health care

International studies consistently demonstrate that individuals diagnosed with severe mental illness (SMI) have an increased risk of co-morbid physical health problems and premature death. During the past decade, government policy in the UK has focused on improving the physical health of those with SMI. Despite this, international research has continued to report barriers to accessing appropriate services. These have been identified as emanating from service users and professionals alike, and also from institutional bureaucracy. Most of this research has reported difficulties from the perspective of various professional groups, with little attention being paid to the service user voice. Studies from the service user perspective undertaken in the past 10 years equate to six qualitative and three quantitative studies, and it appears that poor physical health care remains a problem in the developed world. The quality of this care is compromised by practical problems and interpersonal difficulties between service users and health-care providers and between providers of mental health services and those providing physical health care. This paper presents a review of the nine international studies and discusses the implications for developing policy and practices that could lead to improved physical health-care services for people experiencing SMI.

‘I'm not an outsider, I'm his mother!’ A phenomenological enquiry into carer experiences of exclusion from acute psychiatric settings

Contemporary standards and policies advocate carer involvement in planning, implementing, and evaluating mental health services. Critics have questioned why such standards and policies fail to move from rhetoric to reality, this particularly being applicable to carer involvement within acute psychiatric settings. As there is only limited UK research on this topic, this interpretive phenomenological study was undertaken to explore the perceived level of involvement from the perspective of carers of service users who were admitted to acute inpatient settings within the previous 2 years. Interviews were conducted with four individuals who cared for a loved one with a mental illness. The interview analysis was influenced by Van Manen, whose interpretive approach seeks to generate a deeper understanding of the phenomenon under study. Four main themes emerged: powerlessness, feeling isolated, needing to be recognized and valued, and a desire for partnership. The findings reflect the views expressed by carers in other studies, identifying that while carers seek to work in partnership with health-care professionals, at a clinical level they often feel excluded. The study concludes by discussing ways of improving and promoting carer involvement and advocating a partnership in care approach within acute psychiatry.

Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards

Quality nursing plays a central role in the delivery of contemporary health and social care, with a positive correlation being demonstrated between patient satisfaction and the quality of nursing care received. One way to ensure such quality is to develop metrics that measure the effectiveness of various aspects of care across a variety of settings. Effective mental health nursing is predicated on understanding the lived experiences of service users in order to provide sensitively-attuned nursing care. To achieve this, mental health nurses need to establish the all-important therapeutic relationship, showing compassion and creating a dialogue whereby service users feel comfortable to share their experiences that help contextualize their distress. Indeed, service users value positive attitudes, being listened to, and being able to trust those who provide care, while mental health nurses value their ability to relate through talking, listening, and expressing empathy. However, the literature suggests that within mental health practice, a disproportionate amount of time is taken up by other activities, with little time being spent listening and talking to service users. The present study discusses the evidence relating to the therapeutic relationship in acute mental health wards and explores why, after five decades, it is not recognized as a fundamental metric of mental health nursing.

Using patient experience in nurse education

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The shackles of abuse: unprepared to work at the edges of reason.

Childhood sexual abuse is an international public health problem. Research suggests similar prevalence rates in both Western and non-Western societies. The long-term consequences of child sexual abuse include wide ranging mental health problems in adult life. Psychiatric services and, in particular, counselling has been highlighted as being the most helpful to those who have experienced child sex abuse. This evidence base should be informing mental health nursing education and practice. However, we argue there is a divergence between the discourse of evidence-based theory and practice reality. The aim of this paper is to explore the preparedness of mental health nurses to work with adults who have experienced sexual abuse during their childhood. It is the first part of a three-part research project and reviews the literature relating to how (and if) mental health nurses are prepared to work with those who have sexual abuse histories. An important issue considered in this review is the impact upon patient/nurse relationships as a consequence of the nurse themselves being survivors of sexual abuse. We argue that a number of conflicting discourses need to be addressed, if mental health nurses are to be appropriately prepared to offer cogent, sensitive care to those in their care who are shackled to their past sexual abuse through the confines of their current mental illness.

Young, gifted, and caring: A project narrative of young carers, their mental health, and getting them involved in education, research and practice

Young carers are a global phenomenon. The UK estimates it has in excess of 175 000 young carers, the onset of their caring role often occurring between 8 and 10 years of age. Of these, 17 000 are caring for a parent who has severe mental illness, a significant factor for children entering the health and social care system, as up to 60% experience mental health difficulties themselves. This paper reports on the outcome of a participatory project aimed at better understanding the needs of young people. A World Café event was hosted, bringing together those involved in promoting the mental health of young people in a partnership consortium. The event was led by young service users and carers. Important issues raised by the young carers were being excluded from being included; stuck in the here and now, ignoring the future; a hole in the net; and ensuring the hidden is on the agenda. The World Café gave the university the privilege of insight into what local young carers need to improve their mental health, and more importantly, how we can utilize our skills to help them achieve their goals.

'That was helpful ... no one has talked to me about that before': research participation as a therapeutic activity

There is considerable interest in the various ethical problems associated with undertaking health and social science research. Participants in such research are often considered vulnerable because of their health status, social position, or dependence on others for health and welfare services. Researchers and ethics committees pay scrupulous attention to the identification and amelioration of risks to participants. Rarely are the benefits to participants of engaging in research highlighted or drawn to the attention of potential participants. Such potential benefits need to be considered by researchers and reviewers when considering the balance of benefits and harms associated with research projects. In this paper, we particularly consider the psychotherapeutic benefits of participation in research.

Hearing the voices of young people who self‐harm: Implications for service providers

The incidence of adolescent self-harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self-harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self-harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young peoples experiences of help and support for self-harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self-harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.

Constructing a bricolage of nursing research, education and practice

Drawing upon post doctoral reflections of a shared methodology, the authors explore the use of bricolage as a way of better understanding the inter-related connections between theory, nursing practice and the felt experiences of service users. The origins of bricolage can be traced back to the work of Levi-Strauss, and Denzin and Lincolns contribution to qualitative methodologies. Bricolage is a multifaceted approach to the research process. Differing epistemological positions and mixed methods of data collection are utilised to bring a richer understanding of human beings and the complexities of their lived experiences. For the bricoleur the object of inquiry, cannot be separated from its context, that is the language used to describe it, its historical situatedness and the social and cultural interpretations of its meaning as an entity in the world. The paper discusses the importance of being able to move beyond the notion of the research method being merely a procedure, to one that respects the complexities of the lived world.