Psychiatric Clients Research Articles

Burnout And Its Impact On Nurses And Doctors.

Burnout is a highly researched syndrome resulting from job stress. It is an ultimate response that occurs because of chronic exposure to stressors from the job characterised by the magnitudes/key dimensions which are feeling of cynicism, sense of ineffectiveness, detachment from the job, lack of accomplishment and overwhelming exhaustion.1 This implies that burnout characterised by a variety of factors can cause extreme suffering to an individual. Exhaustion is a central quality of burnout and the most obvious manifestation of this complex syndrome. It refers to feelings of being overextended and depleted on one’s emotional and physical resources. The individual feels drained due to perpetual lack of energy as a result of which, the quality of work responsibility is compromised. The major sources of this exhaustion are work overload and personal conflicts at the work place. The cynicism dimension represents the interpersonal context that refers to negative, callous, or excessively detached response to various aspects of the job which results in the loss if idealism and dehumanisation of others. The inefficacy dimension represents the self-evaluation component of burnout that refers to feeling of incompetence and lack of achievement and productivity in work. Burnout is a cumulative reaction on ongoing occupational stressors. Healthcare professionals, especially clinicians seem to be at particular risk for burnout. Additionally nurses, specifically psychiatric nurses are considered as a group at risk for excessive stress and burnout because they are in constant interaction and frequent interpersonal contact with psychiatric clients and their families.2 These reasons and risk factors can be same in between the professions, however, even within the discipline there are gender differences that calls for further discussions. Continue...

PREVALENCE OF PSYCHIATRIC DISORDERS IN VIOLENT CRIME BEHAVIOUR: CLERKED CLIENTS LIST, FEDERAL MEDICAL CENTRE, KEFFI

Prevalence of psychiatric disorders and violent crime is unprecedented in the national health emergency sectors especially FMC, Keffi health in a box. Psychiatric clients were recorded among the psychiatric cases in the clinic in federal medical centre, Keffi. The cardinal objective of the study is to investigate the prevalence of psychiatric disorders and ways to curtail incidences of psychosocial disorders in the mental behaviour process of the clients under examination. The current states of disturbance of psychiatric patient clinic were characterized by schizophrenia disorder, anxiety disorder, depression disorder, alcoholic, antisocial personality disorder and mental illness and violent crime behaviour. Clinical depression and bipolar disorder were characterized by profoundly sad mood, overwhelming feelings of self-blame, guilt, and worthlessness, appetite disturbance in a recurrent thought of death or suicide. The study revealed that the effective prevalence and treatment for psychiatric clients will enhance management of the psychosocial disorder and the recovering of health well- being of the psychiatric patient’s clinic. The study concluded and recommends that the psychiatric disorders and violent crime were assessed through medical examination and national registers with reported incident psychotic symptoms. The pattern of inner experience and behaviour of violent crime is a significant health problem causing severe medical and social problems, considerable human suffering a huge economic cost. The prevalence of crime rates may supply more information about criminal behaviour than crime registers because of the high rate of unregistered less severe violent crime and therefore underestimate the psychiatric disorders and criminal behaviour.

Effectiveness of family psychoeducation interventions regarding caregivers burden among primary caregivers of psychiatric clients admitted at selected tertiary care hospital, Coimbatore

Effectiveness of family psychoeducation interventions regarding caregivers burden among primary caregivers of psychiatric clients admitted at selected tertiary care hospital, Coimbatore

Healthcare professionals' perceptions of the implementation of the transitional discharge model for community integration of psychiatric clients.

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes.

Predictors of Co-Occurring Substance Use among Asian Americans in Residential Treatment Programs

Although severe and chronic mental disorders are common among Asian Americans in residential treatment programs, little has been known about the prevalence and predictors of co-occurring substance use in this population. The purpose of this study was to examine predictors of co-occurring substance use among Asian Americans with mental disorders in residential treatment programs. This cross-sectional study included 375 clinical records of Asian Americans from residential treatment programs between 2007 and 2011. Demographic variables, principal psychiatric diagnoses, and data on alcohol, stimulant, and marijuana use were obtained from the clinical records. Separate binary logistic regression analyses were used to examine the demographic and diagnostic contributions to the risk of each type of substance use. Findings of this study indicated that the prevalence of co-occurring substance use was about 53% in Asian Americans with mental disorders. Binary logistic regression analyses revealed that male gender, older age, and depressive disorder predicted more alcohol use, but homelessness and schizophrenia predicted less alcohol use. Male gender, homelessness, and smoking predicted more stimulant use. Male gender and younger age predicted more marijuana use. Based on the findings of this study, awareness about co-occurring substance use problems of ethnic minority psychiatric clients should be increased and appropriate substance use prevention and treatment programs should be developed and provided for high-risk groups.

Training students to detect delirium: An interprofessional pilot study

AimThe purpose of this paper is to report nursing student knowledge acquisition and attitude after completing and interprofessional simulation with medical students. IntroductionThe IOM has challenged healthcare educators to teach teamwork and communication skills in interprofessional settings. Interprofessional simulation provides a higher fidelity experience than simulation in silos. Simulation may be particularly useful in helping healthcare workers gain the necessary skills to care for psychiatric clients. Specifically, healthcare providers have difficulty differentiating between dementia and delirium. Recognizing this deficit, an interprofessional simulation was created using medical students in their neurology rotation and senior nursing students. MethodTwenty-four volunteer nursing students completed a pre-survey to assess delirium knowledge and then completed an education module about delirium. Twelve of these students participated in a simulation with medicine students. Pre and Post Kid SIM Attitude questionnaires were completed by all students participating in the simulation. After the simulations were complete, all twenty-four students were asked to complete the post-survey regarding delirium knowledge. ResultsWhile delirium knowledge scores improved in both groups, the simulation group scored higher, but the difference did not reach significance. The simulation group demonstrated a statistically significant improvement in attitudes toward simulation, interprofessional education, and teamwork post simulation compared to their pre-simulation scores. ConclusionNursing students who participated in an interprofessional simulation developed a heightened appreciation for learning communication, teamwork, situational awareness, and interprofessional roles and responsibilities. These results support the use of interprofessional simulation in healthcare education.

Violence During Imprisonment, Forensic Psychiatric Care, and Probation: Correlations and Predictive Validity of the Risk Assessment Instruments COVR, LSI-R, HCR-20V3, and SAPROF

ABSTRACTThis prospective, naturalistic, cohort study was designed to report the one-year rate of violence among Swedish forensic psychiatric clients, during forensic psychiatric care, prison, and probation. Another purpose was to validate the risk assessment instruments COVR, LSI-R, HCR-20V3, and SAPROF in these settings. We assessed 200 detainees undergoing a forensic psychiatric investigation in Stockholm by means of the four instruments, 193 of them were followed up for one year. Violent acts were committed by 23.3% of the participants, and occurred more often at forensic psychiatric hospitals than correctional settings. According to the analyses, the predictive validity was small for COVR (AUC = .61), medium for LSI-R (AUC = .70), and large for HCR-20V3 (AUC = .79) and SAPROF (AUC = .78).

Measuring and Facilitating Client Engagement with Financial Incentives: Implications for Improving Clinical Outcomes in a Mental Health Setting.

Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the "Milestones of Recovery Scale". This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78 % received an initial financial incentive during treatment (were initially engaged), and 93.3 % of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22 % of cases not receiving an initial incentive, only 5.4 % improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.

Vocational Services and Outcomes of Psychiatric Clients from a Midwestern State

Vocational Services and Outcomes of Psychiatric Clients from a Midwestern State

Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry

BackgroundIn outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client’s appreciation of his own problem behaviour is not systematically used for these purposes. The current study tests whether using a new client self-appraisal risk assessment instrument, based on the Short Term Assessment of Risk and Treatability (START), improves the assessment of re-offending risk and can support shared decision making in care planning.MethodsIn a sample of 201 outpatient forensic psychiatric clients, feasibility of client risk assessment, concordance with clinician assessment, and predictive validity of both assessments for violent or criminal behaviour were studied.ResultsAlmost all clients (98 %) were able to fill in the instrument. Agreement between client and case manager on the key risk and protective factors of the client was poor (mean kappa for selection as key factor was 0.15 and 0.09, respectively, and mean correlation on scoring −0.18 and 0.20). The optimal prediction model for violent or criminal behaviour consisted of the case manager’s structured professional risk estimate for violence in combination with the client’s self-appraisal on key risk and protective factors (AUC = 0.70; 95%CI: 0.60–0.80).ConclusionsIn outpatient forensic psychiatry, self-assessment of risk by the client is feasible and improves the prediction of re-offending. Clients and their case managers differ in their appraisal of key risk and protective factors. These differences should be addressed in shared care planning. The new Client Self-Appraisal based on START (CSA) risk assessment instrument can be a useful tool to facilitate such shared care planning in forensic psychiatry.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0500-3) contains supplementary material, which is available to authorized users.

Everyday Ethics: Voices From the Front Line of Community Psychiatry by Paul Brodwin (review)

Paul Brodwin, Everyday Ethics: Voices From the Front Line of Community Psychiatry. Berkeley: University of California Press, 2012. 248 pp.Brodwin's well-researched book is a must-read for anyone interested in the anthropology of psychiatry, work, health care, or moral decision-making. His aim is to show happens in the backstage of medical settings, which he does well (199). Brodwin's book embeds us in the work teams of Eastside Services in a Midwestern city to reveal the extreme conditions and ethical uncertainty in the lives of people with serious psychiatric disabilities and the people struggling to provide them with care.At Eastside, teams of low-paid, bottom of the ladder clinical workers offered Assertive Community Treatment (ACT) model care to clients with serious psychiatric disabilities, such as schizophrenia, bipolar disorder, and major depression. Many Eastside clients also seemed to struggle with addictions, which is true for about 50 percent of people diagnosed with serious mental illnesses in the public mental health system (Drake et al. 2006). ACT clients, according to Brodwin (and the original model developed in Wisconsin [Stein and Test 1980]) were often deemed to be in need of hands-on care in order to reduce rehospitalizations and enhance their participation in the community. At times, they were recipients of outpatient commitment orders, which are often considered to be a controversial imposition of the state on individual liberties.The ACT model of case management has been well-researched, and at least two good ethnographies of case management for people with serious psychiatric disabilities have been published, including Sue Estroff's (1981) classic, Making It Crazy: An Ethnography of Psychiatric Clients in an American Community, and Jerry Floersch's (2002) Meds, Money, and Manners. These books offer intimate perspectives on case management models from the perspectives of service users (Estroff) and from the perspective of front line staff (Floersch).Brodwin's book builds on the findings of these previous studies and makes an important contribution to the literature because he targets very important issues in care and caregiving, and relentlessly questions the ethical uncertainty of mental health care. He asks: how are decisions made about the care of people with serious psychiatric disabilities, why, by whom, and to what end?The book moves us toward understanding the complex answers to these questions. To help guide his understandings of clinical decisionmaking, Brodwin employs the term everyday ethics, which he has borrowed from Donna Haraway (2013). He describes everyday as a species of situated knowledge that is a partial perspective based on one's own way of organizing the world according to one's own local world-view (173). Interspersed in his ethical vignettes are informative discussions of the ways the mental health care system as-is emerged on a policy level, and the ethics of decision-making that the mental health system forces care providers to manage.The work offers a very humanizing perspective of frontline community psychiatry care providers and their efforts to make incredibly important, challenging, and often demoralizing decisions for their clients with psychiatric disabilities. They do so with a very local perspective, Brodwin argues. Brodwin is most interested in moments of rupture when ethical comments do emerge unexpectedly and people take a moment to reflect upon the social they are playing (202).It seems there are two kinds of frontline care providers playing the game in this book. The seemingly well-educated, all-powerful psychiatrist Dr. Young, who operates on his own set of biomedical logics that a person has a medical disease, needs treatment, and cannot be counted on to take care of themselves until they have proven themselves capable of doing so in a very specific, step-by-step way. …

Impact of Psychoeducation on Knowledge of and Attitude Toward Medications in Clients With Schizophrenia and Schizoaffective Disorders.

To examine a psychoeducational intervention's effects on knowledge and attitudes toward antipsychotic medication in clients with schizophrenia and schizoaffective disorders. A one-group pretest-posttest design was employed. A convenience sample (61 psychiatric clients aged 20 or above) was recruited from a Korean mental health center. At baseline, participants had limited knowledge (M = 50.89, range: 27-77, SD = 12.05) of and negative feelings toward antipsychotic medications (M = -.89, range: -8 to 8, SD = 4.27). Both measures significantly improved post-intervention. A psychoeducational intervention improved clients' knowledge of and attitudes toward antipsychotic medications.

LIFEHOPE.EU: lifestyle and healthy outcome in physical education

● People with severe mental illnesses (SMIs) suffer from health inequities and have a higher mortality rate, resulting from a sedentary lifestyle and a high prevalence of undiagnosed and untreated metabolic and cardiovascular risk factors. Cognitive deficits due to SMI symptoms may affect their ability to engage in a healthier lifestyle. ● Programmes for a healthier lifestyle with physical activity components may improve mental and physical health for people with SMIs. In order to increase physical activity among this population, a new approach was developed as an integrated part of daily care. ● This programme included a cognitive support in the shape of cognitive adaptation training (CAT) in order to address cognitive impairments, and provided education and individualized support in natural nursing environments to help individuals engage in physical activity (PHYS) and dietary changes (PHYS/CAT). People with severe mental illness (SMIs) are more prone to physical illnesses, increased mortality and cognitive impairments, all of which negatively influence their daily lives. Physical activity (PHYS) programmes have helped alleviate SMI. LIFEHOPE is an ongoing research project with the purpose of developing a sustainable lifestyle intervention for physical and mental health. PHYS/cognitive adaptation training (CAT) is a newly created lifestyle intervention that provides group education and is based on CAT. It provides individualized support for PHYS and dietary change in a natural nursing environment. The aim of this study was to obtain further knowledge for developing a sustainable lifestyle programme by exploring psychiatric clients' experiences with PHYS and lifestyle habits, which we did by interviewing a local reference group, community mental healthcare users and community mental healthcare workers. Then, we developed a lifestyle programme for people with SMI using information obtained from these focus group interviews. Our results suggest that there is a need for support and education, as well as active interventions, in carrying out PHYS and dietary changes among people with SMIs, and the PHYS/CAT may be a useful strategy.

Nursing Students’ Experiences of Communication with Psychiatric Clients

Nursing Students’ Experiences of Communication with Psychiatric Clients

Prevention of involuntary admission through Family Group Conferencing: a qualitative case study in community mental health nursing.

To understand whether and how Family Group Conferencing might contribute to the social embedding of clients with mental illness. Ensuring the social integration of psychiatric clients is a key aspect of community mental health nursing. Family Group Conferencing has potency to create conditions for clients' social embedding and subsequently can prevent coercive measures. A naturalistic qualitative case study on the process of one conference that was part of 41 conferences that had been organized and studied from January 2011-September 2013 in a public mental health care setting in the north of the Netherlands. Semi-structured interviews (N = 20) were conducted with four stakeholder groups (N = 13) involved in a conference on liveability problems in a local neighbourhood wherein a man with schizophrenia resides. To prevent an involuntary admission to a psychiatric ward of a man with schizophrenia, neighbourhood residents requested a family group conference between themselves, the sister of the man and the mental health organization. As a possible conference aggravated psychotic problems, it was decided to organize it without the client. Nine months after the conference, liveability problems in the neighbourhood had been reduced and coercive measures adverted. The conference strengthened the community and resulted in a plan countering liveability problems. The case indicates that social embedding of clients with severe psychiatric problems can be strengthened by Family Group Conferencing and that hence coercive measures can be prevented. A shift is required from working with the individual client to a community driven approach.

Evaluation of a Theory-Based Education Program to Motivate Nursing Students to Intervene With their Seriously Mentally Ill Clients Who Use Tobacco

Tobacco dependence is a major health problem for persons with a serious mental illness (SMI). Nurses working with psychiatric clients often lack the knowledge, ability, and confidence to offer their clients meaningful, effective help to quit smoking. The purpose of this study was to evaluate the effects of a tobacco education program on the perceived competence and motivation of baccalaureate nursing students (BSN) to intervene with SMI clients who use tobacco. The education program significantly improved the competence and motivation of BSN students to deliver cessation interventions to this vulnerable population of smokers.

Solution-Focused Brief Therapy for Depression in an Indian Tribal Community: A Pilot Study

This study aimed to assess the outcome of solution-focused brief therapy (SFBT) in the context of a tribal community in India and to get some insights about the applicability of solution-focused practice in Indian community mental health settings. The tribal community had a low socio economic status and the clients all had a depressive disorder. The team was comprised of a psychiatrist, a clinical psychologist, a psychiatric social worker, a psychiatric nurse, and a pharmacist, who visit rural areas and later, treats psychiatric clients in their neighbourhood. Nine clients with depression received SFBT along with SSRI medication. The Beck Depression Inventory-II (BDI-II) was used to measure the severity of the depressive symptoms before and after the treatment. The European Brief Therapy Associations SFBT-research protocol was applied in all therapy. The Wilcoxon sign-ranked test was used to analyse the data. Results indicate that there was significant decrease in the severity of distress after the treatment, which suggests SFBT was effective in reducing depressive symptoms in the clients.

Experiences in occupational therapy with Afghan clients in Australia

With a steady increase of refugees arriving in Australia from Afghanistan coupled with reports that prevalence of mental illness amongst Afghan refugees in South-East Melbourne is particularly high, mental health providers will need to acquire cultural competence to provide effective treatment. There is a dearth of literature on the subject of rehabilitation of Afghan psychiatric clients in the Australian context, providing the impetus for this article. To illustrate the impact of Afghan socio-cultural beliefs and attitudes on the implementation of occupational therapy and rehabilitation programmes in a mental health facility and adaptations to accommodate the needs of the clients and their families. Two case vignettes of Afghan clients are presented to illustrate the variance in goals and expectations of the clients and their families to that of the occupational therapy and rehabilitation programmes offered. Family expectations and involvement, culture-specific factors and religion play significant roles in the presentation and treatment of clients from the Muslim culture and require modification in implementation of rehabilitation programmes. A need for developing family or community-based services is proposed coupled with culturally responsive practices. Culture sensitive models of occupational therapy will need to be developed as younger generations of refugee families acculturate and need psychological help to deal with conflicts with parents and elders who hold values different from those adopted by their children born and brought up in the Australian socio-cultural environment. These and other issues mentioned above provide fertile fields for research in this evolving area of occupational therapy.

Preventing Psychiatric Discharge to Homelessness

The present study assessed the effects of an intervention that was designed to provide on-site, predischarge housing assistance for psychiatric clients. Participants included clients from acute (n = 219) and tertiary (n = 32) care hospital sites. Data were collected from hospital and shelter databases. Results revealed that in the majority of cases, the intervention reduced the number of individuals discharged to homelessness or no fixed address. In addition, the costs of implementing and maintaining the intervention were less than the increased medical costs associated with homelessness and housing individuals in shelters.

Preventing Homelessness After Discharge from Psychiatric Wards: Perspectives of Consumers and Staff

After spending time in the hospital, psychiatric clients are often discharged to homeless shelters or the streets, which can place a burden on health care systems. This study examined the effects of an intervention in which psychiatric clients from acute (n = 219) and tertiary (n = 32) sites were provided with predischarge assistance in securing housing. A program evaluation design was used to examine the effectiveness of the intervention. Qualitative data were available through interviews, focus groups, and monthly meetings. The results highlight several benefits of the intervention and show that homelessness can be reduced by connecting housing support, income support, and psychiatric care.