No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Individualised Care in Mental Health and Psychiatric Care: Theory, Measurement, Research and Practice
Abstract
Individualised care has been part of international discussion in mental health services and psychiatric care since 1990s. The discussion is originally based on a wide movement in psychiatry towards community care away from institutionalised and less human approaches in mental health services. However, a connotation of the concept of ‘individualised care’ varies in the literature. There is also a great variation on how the concept of individualised care has been used in different mental healthcare services or in psychiatric care regarding guidelines, strategies, research or educational purposes. In addition, different methods have been used to describe a realisation in individualised care in different target population. In this book chapter, we will first overview how individualised care in mental health and psychiatric care has been defined in different context. Second, we will list the measures and outcomes, which have been used to assess the realisation of individualised care in daily practices. Third, the interventions or programmes used to support individualised care in special target groups will be described. Fourth, the realisation and impact of individualised care will be described.
... Work in a mental health clinic is characterized by several elements, such as unpredictability, difficulties in planning treatment and a high degree of discretion and autonomy, because each patient needs individual care [68]. All these elements are based on strong, professional values on which treatment and care rest. ...
... All these elements are based on strong, professional values on which treatment and care rest. First, the elements of autonomy and individuality collide with some of the intentions of the pathway system, such as efficiency, equality and standardization [68,69]. This incongruity makes the implementation of these measures difficult, as Sutcliffe [62] explains, when the actors involved understand, judge and interpret the care pathways from a professional identity. ...
Background
In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle.
The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation.
Methods
Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults.
Results
The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals’ distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation.
Conclusion
Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.
... To reduce widespread and recurrent use of services, it may be beneficial for first-line SUD interventions to attend to homeless veterans' unique and complex needs. Tailored mental health and SUD treatments that consider a biopsychosocial model are unequivocally beneficial to treatment outcomes regardless of disorder or population (Afuseh et al., 2020;Dixon et al., 2016;Engel, 1977;Marchand et al., 2019;Välimäki & Lantta, 2019). Moreover, patients prefer and encourage individually tailored treatment and find it superior to a "one size fits all" approach (Li et al., 2024). ...
The high prevalence of military veteran substance use (SU) when compared to their nonveteran counterparts has been described as an urgent public health issue. The commonality of severe mental and physical health comorbidities in this population affects their ability to recover and relates to the onset and maintenance of homelessness. While veteran-targeted housing and SU interventions exist, they are being underutilized. This scoping review synthesizes published peer-reviewed articles from 1990 to 2021 at the intersections of housing, substance abuse, and service utilization by homeless veterans. Qualitative thematic analysis of 119 retained peer-reviewed articles revealed five key themes: (1) the association between SU and housing stability, (2) gendered comparisons with service needs and provision, (3) consideration for comorbidities, (4) social support and relationship-centered interventions, and (5) barriers to health care services. This review offers a series of concerns, outcomes, and recommendations that might be valuable for practitioners, health care providers, and community stakeholders when implementing or re-evaluating new or existing homeless veteran treatment programs.
... Some of the needs and experiences of dependent children whose parents have a mental illness will differ from those of adult children who may be parents themselves (Patrick et al., 2019). Indeed, mental health clinicians are trained to adapt their practice to each client's context, including age, culture and risk factors (Välimäki & Lantta 2019). Similarly, we recommend that the promotion of self-compassion assumes a developmental approach, for example using creative approaches to teaching self-compassion, involving art, music or storytelling, especially when promoting self-compassion with children and youth. ...
Objectives:
Individuals who have a parent with mental illness are more likely to experience mental illness than their contemporaries. As such, it is valuable to examine potential psychological resources, which might assist these individuals to experience good mental health throughout their lifespan. We aimed to learn how clinicians perceive self-compassion, and how it can be incorporated into therapy with clients who have parents with mental illness.
Design:
A qualitative interview design was employed to explore clinicians' perspectives and experiences.
Methods:
Eight mental health clinicians experienced in working with clients who have parents with mental illness were interviewed. Interpretative phenomenological analysis was used to establish themes representing the clinicians' perspectives and experiences of incorporating self-compassion into their work.
Results:
This study found that clinicians were generally positive about incorporating self-compassion into interventions with clients who are children of parents with mental illness. The participants noted barriers to self-compassion for these clients, namely a poor sense of self and divided loyalty between self and family. Participants recommended taking time and care, building rapport and involving others when cultivating self-compassion with those who have parents with mental illness.
Conclusions:
This group of clinicians viewed self-compassion as relevant to clients whose parents have mental illness and believe it can be introduced therapeutically in various ways. Suggestions are made for tailoring self-compassion training to the needs and experiences of this group.
... The principle underpinning our thinking is that there is a trend to provide increasingly more individualised opportunities in several other domains, for example marketing, education and medicine, through the application of other novel 21st century technologies. Even though the concept of individualised care in mental health has been discussed [48], it has not been applied to technology-assisted mental health support. ...
... Medicine is becoming more tailored to the individual, driven by new digital technology advancements; moving from one-size-fits-all to 'personalised medicine', where care delivery is tailored to the individual, thereby offering potential for higher cure rates and fewer side effects [46]. Even though the concept of individualised care in mental health has been discussed [51], it has not been applied to technology assisted mental health support. ...
... Medicine is becoming more tailored to the individual; moving from one-size-fits-all to 'personalised medicine', where care delivery is tailored to the individual thereby offering potential for higher cure rates and fewer side effects [46]. Even though the concept of individualised care in mental health has been discussed [51], it has not been applied to technology assisted mental health support. ...
Mental health conditions pose a major challenge to healthcare providers and society at large. Early intervention can have significant positive impact on a person's prognosis, particularly important in improving mental health outcomes and functioning for young people. Virtual Reality (VR) in mental health is an emerging and innovative field. Recent studies support the use of VR technology in the treatment of anxiety, phobia, eating disorders, addiction, and pain management. However, there is little research on using VR for supporting, treatment and prevention of depression - a field that is very much emerging. There is also very little work done in offering individualised VR experience to users with mental health issues. This paper proposes iVR, a novel individualised VR for improving users' self-compassion, and in the long run, their positive mental health. We describe the concept, design, architecture and implementation of iVR and outline future work. We believe this contribution will pave the way for large-scale efficacy testing, clinical use, and potentially cost-effective delivery of VR technology for mental health therapy in future.
... Medicine is becoming more tailored to the individual; moving from one-size-fits-all to 'personalised medicine', where care delivery is tailored to the individual thereby offering potential for higher cure rates and fewer side effects [46]. Even though the concept of individualised care in mental health has been discussed [51], it has not been applied to technology assisted mental health support. ...
Mental health conditions pose a major challenge to healthcare providers and society at large. Early intervention can have significant positive impact on a person's prognosis, particularly important in improving mental health outcomes and functioning for young people. Virtual Reality (VR) in mental health is an emerging and innovative field. Recent studies support the use of VR technology in the treatment of anxiety, phobia, eating disorders, addiction, and pain management. However, there is little research on using VR for supporting, treatment and prevention of depression - a field that is very much emerging. There is also very little work done in offering individualised VR experience to users with mental health issues. This paper proposes iVR, a novel individualised VR for improving users' self-compassion, and in the long run, their positive mental health. We describe the concept, design, architecture and implementation of iVR and outline future work. We believe this contribution will pave the way for large-scale efficacy testing, clinical use, and potentially cost-effective delivery of VR technology for mental health therapy in future.
A comprehensive examination of pharmacological interventions for the management of binge eating disorder (BED) is presented in this chapter. The article examines the safety and effectiveness of psychostimulants, selective serotonin reuptake inhibitors (SSRIs), antiepileptic medications, and personalized medicine strategies that account for genetic and treatment response variations among individuals. The text also discusses forthcoming challenges and prospects in pharmaceutical development and execution, underscoring the criticality of patient-centred, multidisciplinary treatment to maximize efficacy.
Aim
One of the most commonly used tools for measuring job satisfaction in nursing is the Stamps Index of Work Satisfaction. Several studies have reported on the reliability of the Stamps' tool based on traditional statistical model. The aim of this study was to apply the Rasch model to examine the adequacy of Stamps's Index of Work Satisfaction for measuring nurses' job satisfaction cross‐culturally and to determine the validity and reliability of the instrument using the Rasch criteria.
Design
A secondary data analysis was conducted on a sample of 556 registered nurses from two countries.
Methods
The RUMM 2030 software was used to analyse the psychometric properties of the Index of Work Satisfaction.
Results
The persons mean location of ‐0.018 approximated the items mean of 0.00, suggesting a good alignment of the measure and the traits being measured. However, at the items level, some items were misfiting to the Rasch model.
Background:
Psychological interventions are increasingly recommended as adjunctive treatments for psychosis, but their implementation in clinical practice is still insufficient. The individualized metacognitive therapy program (MCT+; www.uke.de/mct_plus ) represents a low-threshold psychotherapeutic approach that synthesizes group metacognitive training (MCT) and cognitive behavioral therapy for psychosis, and addresses specific cognitive biases that are involved in the onset and maintenance of psychosis. It aims to "plant the seed of doubt" regarding rigid delusional convictions and to encourage patients to critically reflect, extend and change their approach to problem solving. Its second edition also puts more emphasis on affective symptoms. A recent meta-analysis of metacognitive interventions (MCT, MCT+) indicate small to moderate effects on positive symptoms and delusions, as well as high rates of acceptance. Nonetheless, no long-term studies of MCT+ involving large samples have been conducted.
Methods:
The goal of the present multi-center, observer-blind, parallel-group, randomized controlled trial is to compare the efficacy of MCT+ against an active control (cognitive remediation; MyBrainTraining(©)) in 328 patients with psychosis at three time points (baseline, immediately after intervention [6 weeks] and 6 months later). The primary outcome is change in psychosis symptoms over the 6-month follow-up period as assessed by the delusion subscale of the Psychotic Symptom Rating Scale. Secondary outcomes include jumping to conclusions, other positive symptoms of schizophrenia, depressive symptoms, self-esteem, quality of life, and cognitive insight. The study also seeks to elucidate mediating factors that promote versus impede symptom improvement across time.
Discussion:
This is the first multi-center randomized controlled trial to test the efficacy of individualized MCT+ in a large sample of patients with psychosis. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.
Trial registration:
The trial is registered through the German Clinical Trials Register ( www.drks.de ) as DRKS00008001 . Registered 6 May 2015.
Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
Nearly half of individuals with substance use disorders relapse in the year after treatment. A diagnostic tool to help clinicians make decisions regarding treatment does not exist for psychiatric conditions. Identifying individuals with high risk for relapse to substance use following abstinence has profound clinical consequences. This study aimed to develop neuroimaging as a robust tool to predict relapse.
68 methamphetamine-dependent adults (15 female) were recruited from 28-day inpatient treatment. During treatment, participants completed a functional MRI scan that examined brain activation during reward processing. Patients were followed 1 year later to assess abstinence. We examined brain activation during reward processing between relapsing and abstaining individuals and employed three random forest prediction models (clinical and personality measures, neuroimaging measures, a combined model) to generate predictions for each participant regarding their relapse likelihood.
18 individuals relapsed. There were significant group by reward-size interactions for neural activation in the left insula and right striatum for rewards. Abstaining individuals showed increased activation for large, risky relative to small, safe rewards, whereas relapsing individuals failed to show differential activation between reward types. All three random forest models yielded good test characteristics such that a positive test for relapse yielded a likelihood ratio 2.63, whereas a negative test had a likelihood ratio of 0.48.
These findings suggest that neuroimaging can be developed in combination with other measures as an instrument to predict relapse, advancing tools providers can use to make decisions about individualized treatment of substance use disorders.
Published by Elsevier Ireland Ltd.
Counseling psychologists often work with clients to increase their well-being as well as to decrease their distress. One important aspect of well-being, highlighted particularly in humanistic theories of the counseling process, is perceived meaning in life. However, poor measurement has hampered research on meaning in life. In 3 studies, evidence is provided for the internal consistency, temporal stability, factor structure, and validity of the Meaning in Life Questionnaire (MLQ), a new 10-item measure of the presence of, and the search for, meaning in life. A multitrait-multimethod matrix demonstrates the convergent and discriminant validity of the MLQ subscales across time and informants, in comparison with 2 other meaning scales. The MLQ offers several improvements over current meaning in life measures, including no item overlap with distress measures, a stable factor structure, better discriminant validity, a briefer format, and the ability to measure the search for meaning.
The purpose of this research was to develop and evaluate psychometrically an abbreviated instrument to assess hope in adults in clinical settings. The Herth Hope Index (HHI), a 12-item adapted version of the Herth Hope Scale (HHS), was tested with a convenience sample of 172 ill adults. Alpha coefficient was 0.97 with a 2-week test-retest reliability of 0.91. Criterion-related validity was established by correlating the HHI with the parent HHS (r = 0.92), the Existential Well-Being Scale (r = 0.84) and the Nowotny Hope Scale (r = 0.81). Divergent validity with the Hopelessness Scale was established (r = -0.73). Construct validity was supported through the factorial isolation of three factors: (a) temporality and future; (b) positive readiness and expectancy; (c) interconnectedness. These three factors accounted for 41% of the total variance in the measure.
A scale to measure the personal construct of empowerment as defined by consumers of mental health services was developed and field tested.
After extensive development, pilot testing, and analyses, a 28-item scale to measure empowerment was tested on 271 members of six self-help programs in six states. Factor analyses were used to identify the underlying dimensions of empowerment. To establish the scale's reliability and validity, responses were factor analyzed, and other analyses were conducted.
Analyses revealed five factors: self-efficacy-self-esteem, power-powerlessness, community activism, righteous anger, and optimism-control over the future. Empowerment was related to quality of life and income but not to the demographic variables of age, gender, ethnicity, marital status, education level, or employment status. Empowerment was inversely related to use of traditional mental health services and positively related to community activism.
The findings set a framework for a clearer understanding of the imprecise and overused concept of empowerment. The scale demonstrated adequate internal consistency and some evidence for validity. Further testing must be done to establish whether it has discriminant validity and is sensitive to change.
Background Based on experiences and empirical evidence gained in studies using the Lancashire Quality of Life Profile (LQLP), the Manchester Short Assessment of Quality of Life (MANSA) has been developed as a condensed and slightly modified instrument for assessing quality of life. Its properties have been tested in a sample of community care patients.
Method Fifty-five randomly selected patients on the Care Programme Approach were interviewed using the LQLP, the MANSA and the Brief Psychiatric Rating Scale.
Results Correlations between subjective quality of life scores on MANSA and LQLP were all 0.83 or higher (0.94 for the satisfaction mean score). Cronbach's alpha for satisfaction ratings was 0.74, and association with psychopathology was in line with results for LQLP as reported in the literature.
Conclusions The MANSA is a brief instrument for assessing quality of life focusing on satisfaction with life as a whole and with life domains. Its psychometric properties appear satisfactory.
There is concern about the stigma of mental illness, but it is difficult to measure stigma consistently.
To develop a standardised instrument to measure the stigma of mental illness.
We used qualitative data from interviews with mental health service users to develop a pilot scale with 42 items. We recruited 193 service users in order to standardise the scale. Of these, 93 were asked to complete the questionnaire twice, 2 weeks apart, of whom 60 (65%) did so. Items with a test-retest reliability kappa coefficient of 0.4 or greater were retained and subjected to common factor analysis.
The final 28-item stigma scale has a three-factor structure: the first concerns discrimination, the second disclosure and the third potential positive aspects of mental illness. Stigma scale scores were negatively correlated with global self-esteem.
This self-report questionnaire, which can be completed in 5-10 min, may help us understand more about the role of stigma of psychiatric illness in research and clinical settings.
There is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).
WEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbach's alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding.
WEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbach's alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test-retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales.
WEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scale's sensitivity to change is established before it is recommended in this context.
The aim of the present study was to establish the feasibility of conducting a full-scale trial and to estimate the preliminary effect of a Chinese Health Improvement Profile (CHIP) intervention on self-reported physical well-being of people with severe mental illness (SMI). The study used a parallel-group, open-label, cluster-randomized, controlled trial (RCT) design. Twelve community psychiatric nurses (CPN) and their corresponding 137 patients with SMI were randomized into the CHIP or treatment-as-usual (TAU) groups. After training, the CPN completed the CHIP at baseline and 12 months, and the findings were used to devise an individualized care plan to promote health behaviour change. Patients were assessed at baseline and 6 and 12 months after starting the intervention. There was an observed positive trend of improvement on the physical component subscale of SF12v2 in the CHIP group compared to the TAU group after 12 months, but the difference did not reach statistical significance (P = 0.138). The mental component subscale showed a similar positive trend (P = 0.077). CHIP participants were more satisfied with their physical health care than TAU patients (P = 0.009), and the CPN were positive about the usefulness/acceptability of the intervention. There were significant within-group improvements in the total numbers of physical health risks, as indicated by the CHIP items (P = 0.005). The findings suggest that it is feasible to conduct a full-scale RCT of the CHIP in future. The CHIP is an intervention that can be used within routine CPN practice, and could result in small–modest improvements in the physical well-being of people with SMI.
Objective:
Premature discontinuation of therapy is a widespread problem that hampers the delivery of mental health treatment. A high degree of variability has been found among rates of premature treatment discontinuation, suggesting that rates may differ depending on potential moderators. In the current study, our aim was to identify demographic and interpersonal variables that moderate the association between treatment assignment and dropout.
Methods:
Data from a randomized controlled trial conducted from November 2001 through June 2007 (N = 156) comparing supportive-expressive therapy, antidepressant medication, and placebo for the treatment of depression (based on DSM-IV criteria) were used. Twenty prerandomization variables were chosen based on previous literature. These variables were subjected to exploratory bootstrapped variable selection and included in the logistic regression models if they passed variable selection.
Results:
Three variables were found to moderate the association between treatment assignment and dropout: age, pretreatment therapeutic alliance expectations, and the presence of vindictive tendencies in interpersonal relationships. When patients were divided into those randomly assigned to their optimal treatment and those assigned to their least optimal treatment, dropout rates in the optimal treatment group (24.4%) were significantly lower than those in the least optimal treatment group (47.4%; P = .03).
Conclusions:
Present findings suggest that a patient's age and pretreatment interpersonal characteristics predict the association between common depression treatments and dropout rate. If validated by further studies, these characteristics can assist in reducing dropout through targeted treatment assignment.
Trial registration:
Secondary analysis of data from ClinicalTrials.gov identifier: NCT00043550.
We described an individualized occupational therapy (IOT) programme and examined the effects of adding IOT to group OT (GOT) on improving neurocognition, symptoms and social functioning among recently hospitalized patients with schizophrenia. The Brief Assessment of Cognition in Schizophrenia—Japanese version (BACS-J), the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale were used for outcome evaluations. Fifty-one patients were voluntarily assigned to either the GOT + IOT (n = 30) or GOT alone (n = 21) groups based on their preferences. Retention in the GOT + IOT group was 100%. Three-month baseline to discharge assessments in the GOT + IOT group showed significant improvements in BACS-J verbal memory, working memory, verbal fluency, attention, executive function and composite score, and in PANSS positive subscale, general psychopathology subscale, and total score compared to the GOT alone group. Study limitations notwithstanding, the present findings provide preliminary support for the feasibility of implementing IOT and its effectiveness for improving cognitive impairment and symptoms in patients with schizophrenia. The results of this study indicate that IOT in psychiatric facilities may improve psychosocial treatment of schizophrenia. Additional study is warranted to replicate the effects of IOT as demonstrated in this Japanese study. Copyright
Objective:
Approximately 20%-35% of individuals 12-35 years old who meet criteria for a prodromal risk syndrome convert to psychosis within 2 years. However, this estimate ignores the fact that clinical high-risk cases vary considerably in risk. The authors sought to create a risk calculator, based on profiles of risk indicators, that can ascertain the probability of conversion to psychosis in individual patients.
Method:
The study subjects were 596 clinical high-risk participants from the second phase of the North American Prodrome Longitudinal Study who were followed up to the time of conversion to psychosis or last contact (up to 2 years). The predictors examined were limited to those that are supported by previous studies and are readily obtainable in general clinical settings. Time-to-event regression was used to build a multivariate model predicting conversion, with internal validation using 1,000 bootstrap resamples.
Results:
The 2-year probability of conversion to psychosis was 16%. Higher levels of unusual thought content and suspiciousness, greater decline in social functioning, lower verbal learning and memory performance, slower speed of processing, and younger age at baseline each contributed to individual risk for psychosis. Stressful life events, trauma, and family history of schizophrenia were not significant predictors. The multivariate model achieved a concordance index of 0.71 and, as reported in an article by Carrión et al., published concurrently with this one, was validated in an independent external data set. The results are instantiated in a web-based risk prediction tool envisioned to be most useful in research protocols involving the psychosis prodrome.
Conclusions:
A risk calculator comparable in accuracy to those for cardiovascular disease and cancer is available to predict individualized conversion risks in newly ascertained clinical high-risk cases. Given that the risk calculator can be validly applied only for patients who screen positive on the Structured Clinical Interview for Psychosis Risk Syndromes, which requires training to administer, its most immediate uses will be in research on psychosis risk factors and in research-driven clinical (prevention) trials.
Employment is a key to participation in community life for people with severe mental illness, especially those who have been involved in the criminal justice system. Although the Individual Placement and Support (IPS) model of supported employment has been established as an evidence-based practice for helping people with severe mental illness attain competitive employment, little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration. This study examined this question.
A randomized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support.
At one-year follow-up, a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment (31% versus 7%; p<.01). The IPS and comparison groups did not differ significantly during follow-up in rates of hospitalization (51% versus 40%) or justice involvement-either arrests (24% versus 19%) or incarceration (2% for both groups).
Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment, the outcomes were modest compared with those in prior IPS studies. The IPS model provided a useful framework for employment services for this population, but augmentations may be needed.
Some of the latest advances in personalized psychiatry with future research directions are discussed in this article. Many factors contribute to the phenotypic psychiatric profile in individual patients. These overlapping factors include but are not limited to genetics, epigenetics, central nervous system circuit alterations, family history, past personal history, environmental influences including early life stress, and more recent life stressors. The authors discuss the role of pharmacogenomics, particularly in the cytochrome P450 enzyme system in relation to treatment response. Despite some promising advances in personalized medicine in psychiatry, it is still in its early phases of development.
Copyright © 2015 Elsevier Inc. All rights reserved.
Magnetic resonance imaging-based markers of schizophrenia have been repeatedly shown to separate patients from healthy controls at the single-subject level, but it remains unclear whether these markers reliably distinguish schizophrenia from mood disorders across the life span and generalize to new patients as well as to early stages of these illnesses. The current study used structural MRI-based multivariate pattern classification to (i) identify and cross-validate a differential diagnostic signature separating patients with first-episode and recurrent stages of schizophrenia (n = 158) from patients with major depression (n = 104); and (ii) quantify the impact of major clinical variables, including disease stage, age of disease onset and accelerated brain ageing on the signature's classification performance. This diagnostic magnetic resonance imaging signature was then evaluated in an independent patient cohort from two different centres to test its generalizability to individuals with bipolar disorder (n = 35), first-episode psychosis (n = 23) and clinically defined at-risk mental states for psychosis (n = 89). Neuroanatomical diagnosis was correct in 80% and 72% of patients with major depression and schizophrenia, respectively, and involved a pattern of prefronto-temporo-limbic volume reductions and premotor, somatosensory and subcortical increments in schizophrenia versus major depression. Diagnostic performance was not influenced by the presence of depressive symptoms in schizophrenia or psychotic symptoms in major depression, but earlier disease onset and accelerated brain ageing promoted misclassification in major depression due to an increased neuroanatomical schizophrenia likeness of these patients. Furthermore, disease stage significantly moderated neuroanatomical diagnosis as recurrently-ill patients had higher misclassification rates (major depression: 23%; schizophrenia: 29%) than first-episode patients (major depression: 15%; schizophrenia: 12%). Finally, the trained biomarker assigned 74% of the bipolar patients to the major depression group, while 83% of the first-episode psychosis patients and 77% and 61% of the individuals with an ultra-high risk and low-risk state, respectively, were labelled with schizophrenia. Our findings suggest that neuroanatomical information may provide generalizable diagnostic tools distinguishing schizophrenia from mood disorders early in the course of psychosis. Disease course-related variables such as age of disease onset and disease stage as well alterations of structural brain maturation may strongly impact on the neuroanatomical separability of major depression and schizophrenia.
© The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Initiating antipsychotic medication frequently induces rapid, clinically significant weight gain. We aimed to evaluate the effectiveness of a lifestyle and life skills intervention, delivered within 4 weeks of antipsychotic medication initiation, in attenuating weight gain in youth aged 14-25 years with first-episode psychosis (FEP).
We undertook a prospective, controlled study in two early psychosis community services. Intervention participants (n = 16) received a 12-week individualized intervention delivered by specialist clinical staff (nurse, dietician and exercise physiologist) and youth peer wellness coaches, in addition to standard care. A comparison group was recruited from a similar service and received standard care (n = 12).
The intervention group experienced significantly less weight gain at 12 weeks compared to standard care (1.8 kg, 95% CI -0.4 to 2.8 vs. 7.8 kg, 4.8-10.7, P < 0.001). Thirteen per cent (2/16) of the intervention group experienced clinically significant weight gain (greater than 7% of baseline weight), while 75% (9/12) of the standard care group experienced this level of weight gain. Similar positive effects of the intervention were observed for waist circumference.
A lifestyle and life skills intervention delivered as part of standard care attenuated antipsychotic-induced weight gain in young people with FEP. The intervention was acceptable to the young people referred to the service. Such interventions may prevent the seeding of future disease risk and in the long-term help reduce the life expectancy gap for people living with serious mental illness.
© 2015 Wiley Publishing Asia Pty Ltd.
We conducted a meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome. Our search of the literature resulted in 35 empirical articles describing 33 unique clinical trials that either randomized some clients to an active choice condition (shared decision making condition or choice of treatment) or assessed client preferences. Clients who were involved in shared decision making, chose a treatment condition, or otherwise received their preferred treatment evidenced higher treatment satisfaction (ESd = .32; p < .001), increased completion rates (ESOR = 1.37; ESd = .17; p < .001), and superior clinical outcome (ESd = .19; p < .0001), compared to clients who were not involved in shared decision making, did not choose a treatment condition, or otherwise did not receive their preferred treatment. Although the effect sizes are modest in magnitude, they were generally consistent across several potential moderating variables including study design (preference versus active choice), psychoeducation (informed versus uninformed), setting (inpatient versus outpatient), client diagnosis (mental health versus other), and unit of randomization (client versus provider). Our findings highlight the clinical benefit of assessing client preferences, providing treatment choices when two or more efficacious options are available, and involving clients in treatment-related decisions when treatment options are not available.
Teams of people working together for a common purpose have been a centerpiece of human social organization ever since our ancient ancestors first banded together to hunt game, raise families, and defend their communities. Human history is largely a story of people working together in groups to explore, achieve, and conquer. Yet, the modern concept of work in large organizations that developed in the late 19th and early 20th centuries is largely a tale of work as a collection of individual jobs. A variety of global forces unfolding over the last two decades, however, has pushed organizations worldwide to restructure work around teams, to enable more rapid, flexible, and adaptive responses to the unexpected. This shift in the structure of work has made team effectiveness a salient organizational concern.
Teams touch our lives everyday and their effectiveness is important to well-being across a wide range of societal functions. There is over 50 years of psychological research—literally thousands of studies—focused on understanding and influencing the processes that underlie team effectiveness. Our goal in this monograph is to sift through this voluminous literature to identify what we know, what we think we know, and what we need to know to improve the effectiveness of work groups and teams.
We begin by defining team effectiveness and establishing the conceptual underpinnings of our approach to understanding it. We then turn to our review, which concentrates primarily on topics that have well-developed theoretical and empirical foundations, to ensure that our conclusions and recommendations are on firm footing. Our review begins by focusing on cognitive, motivational/affective, and behavioral team processes—processes that enable team members to combine their resources to resolve task demands and, in so doing, be effective. We then turn our attention to identifying interventions, or “levers,” that can shape or align team processes and thereby provide tools and applications that can improve team effectiveness. Topic-specific conclusions and recommendations are given throughout the review. There is a solid foundation for concluding that there is an emerging science of team effectiveness and that findings from this research foundation provide several means to improve team effectiveness. In the concluding section, we summarize our primary findings to highlight specific research, application, and policy recommendations for enhancing the effectiveness of work groups and teams.
It is important to seek cost-effective methods of improving the care and outcome of those with serious mental illnesses. User-held records, where the person with the illness holds all or some personal information relating to the course and care of their illness, are now the norm in some clinical settings. Their value for those with severe mental illnesses is unknown.
To evaluate the effects of personalised, accessible, user-held clinical information for people with a severe mental illness (defined as psychotic illnesses).
We updated previous searches by searching the Cochrane Schizophrenia Group Trials Register in August 2011. This register is compiled by systematic searches of major databases, and handsearches of journals and conference proceedings.
We included all relevant randomised controlled trials (RCTs) that:i. have recruited adult participants with a diagnosis of a severe mental illness (specifically psychotic illnesses and severe mood disorders such as bipolar and depression with psychotic features); andii. compared any personalised and accessible clinical information held by the user beyond standard care to standard information routinely held such as appointment cards and generic information on diagnosis, treatment or services available.
Study selection and data extraction were undertaken independently by two authors and confirmed and checked by a third. We contacted authors of trials for additional and missing data. Where possible, we calculated risk ratios (RR) and 95% confidence intervals (CI). We used a random-effects model. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE.
Four RCTs (n = 607) of user-held records versus treatment as usual met the inclusion criteria. When the effect of user-held records on psychiatric hospital admissions was compared with treatment as usual in four studies, the pooled treatment effect showed no significant impact of the intervention and was of very low magnitude (n = 597, 4 RCTs, RR 0.99 CI 0.71 to 1.38, moderate quality evidence). Similarly, there was no significant effect of the intervention in three studies which investigated compulsory psychiatric hospital admissions (n = 507, 4 RCTs, RR 0.64 CI 0.37 to 1.10, moderate quality evidence). Other outcomes including satisfaction and mental state were investigated but pooled estimates were not obtainable due to skewed or poorly reported data, or only being investigated by one study. Two outcomes (violence and death) were not investigated by the included studies. Two important randomised studies are ongoing.
The evidence gap remains regarding user-held, personalised, accessible clinical information for people with psychotic illnesses for many of the outcomes of interest. However, based on moderate quality evidence, this review suggests that there is no effect of the intervention on hospital or outpatient appointment use for individuals with psychotic disorders. The number of studies is low, however, and further evidence is required to ascertain whether these results are mediated by the type of intervention, such as involvement of a clinical team or the type of information included.
Psychiatric patients tend to exhibit significant interindividual variability in their responses to psychoactive drugs, as well as an irregular clinical course. For these (and other) reasons, increasing numbers of psychiatrists are turning to genotyping for help in selecting the psychopharmacologic agents best suited to an individual patient's distinctive metabolic characteristics and clinical presentation. Fortunately, routine genotyping is already available for gene variations that code for proteins involved in neurotransmission, and for drug-metabolizing enzymes involved in the elimination of many medications. Thus, genotyping-based personalized psychiatry is now in sight. Increasing numbers of clinically useful DNA microarrays are in the development stage, including a simplified procedure for genotyping patients for CYP2D6, which metabolizes a high proportion of the currently prescribed antidepressants and antipsychotics. It has been pointed out that psychiatric disease is rarely a consequence of an abnormality in a single gene, but reflects the perturbations of complex intracellular networks in the brain. Thus, analysis of functional neuronal networks is becoming an essential component of drug development strategies. The integrated use of technologies such as electroencephalography, magnetoencephalography, functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI), in combination with pharmacogenetics, promises to transform our understanding of the mechanisms of psychiatric disorders and their treatment. The concept of network medicine envisions a time to come when drugs will be used to target a neural network rather than simply components within the network. Personalized medicine in psychiatry is still at an early stage, but it has a very promising future.
Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.
Many states have developed systems of care which are organized networks of service alternatives for children with emotional disabilities. However, in some states, these systems did not have a positive effect on the most disabled of youth and their families. A viable option is wrap-around or individualized services which, when integrated into system of care services, can be more effective and less expensive.
Accessible summary
Little is known of how a comprehensive mental health nursing assessment is undertaken in practice.
Nurses describe the content of a comprehensive mental health nursing assessment in different ways.
Different content may lead to different interventions.
More work is required to ensure comprehensive mental health nursing assessments are undertaken in practice.
Abstract
Assessment is the foundation of mental health nursing practice, but little is known of how it is undertaken. This paper explores how mental health nurses describe the content of a comprehensive mental health nursing assessment. Eighteen nurses who worked in inpatient and community settings either as clinicians or managers, ranging from new graduates to nurses with greater than 20 years of experience, were interviewed and asked to describe the content of a comprehensive mental health nursing assessment. Transcribed interviews were analysed using a grounded theory methodology. The primary theme to emerge was one of variability. Most respondents hesitated and then identified different content areas that needed to be assessed as part of a comprehensive mental health nursing assessment. If the areas that are being assessed vary between nurses, then logically the types of interventions being offered will also vary. These results have implications for the education of nurses, their clinical practice, ongoing supervision and research into contemporary mental health nursing practice.
Systematic review of the literature.
To summarize peer-reviewed literature on the reliability, validity, and responsiveness of the Patient-Specific Functional Scale (PSFS), and to identify its use as an outcome measure.
Searches were performed of several electronic databases from 1995 to May 2010. Studies included were published articles containing (1) primary research investigating the psychometric and clinimetrics of the PSFS or (2) the implementation of the PSFS as an outcome measure. We assessed the methodological quality of studies included in the first category.
Two hundred forty-two articles published from 1994 to May 2010 were identified. Of these, 66 met the inclusion criteria for this review, with 13 reporting the measurement properties of the PSFS, 55 implementing the PSFS as an outcome measure, and 2 doing both of the above. The PSFS was reported to be valid, reliable, and responsive in populations with knee dysfunction, cervical radiculopathy, acute low back pain, mechanical low back pain, and neck dysfunction. The PSFS was found to be reliable and responsive in populations with chronic low back pain. The PSFS was also reported to be valid, reliable, or responsive in individuals with a limited number of acute, subacute, and chronic conditions. This review found that the PSFS is also being used as an outcome measure in many other conditions, despite a lack of published evidence supporting its validity in these conditions.
Although the use of the PSFS as an outcome measure is increasing in physiotherapy practice, there are gaps in the research literature regarding its validity, reliability, and responsiveness in many health conditions.
Nurse staffing interventions have been introduced across countries in recent years in response to changing patient requirements, developments in patient care, and shortages of qualified nursing staff. These include changes in skill mix, grade mix or qualification mix, staffing levels, nursing shifts or nurses' work patterns. Nurse staffing has been closely linked to patient outcomes, organisational outcomes such as costs, and staff-related outcomes.
Our aim was to explore the effect of hospital nurse staffing models on patient and staff-related outcomes.
We searched the following databases from inception through to May 2009: Cochrane/EPOC resources (DARE, CENTRAL, the EPOC Specialised Register), PubMed, EMBASE, CINAHL Plus, CAB Health, Virginia Henderson International Nursing Library, the Joanna Briggs Institute database, the British Library, international theses databases, as well as generic search engines.
Randomised control trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses of interventions relating to hospital nurse staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective measure of patient or staff-related outcome.
Seven reviewers working in pairs independently extracted data from each potentially relevant study and assessed risk of bias.
We identified 6,202 studies that were potentially relevant to our review. Following detailed examination of each study, we included 15 studies in the review. Despite the number of studies conducted on this topic, the quality of evidence overall was very limited. We found no evidence that the addition of specialist nurses to nursing staff reduces patient death rates, attendance at the emergency department, or readmission rates, but it is likely to result in shorter patient hospital stays, and reductions in pressure ulcers. The evidence in relation to the impact of replacing Registered Nurses with unqualified nursing assistants on patient outcomes is very limited. However, it is suggested that specialist support staff, such as dietary assistants, may have an important impact on patient outcomes. Self-scheduling and primary nursing may reduce staff turnover. The introduction of team midwifery (versus standard care) may reduce medical procedures in labour and result in a shorter length of stay without compromising maternal or perinatal safety. We found no eligible studies of educational interventions, grade mix interventions, or staffing levels and therefore we are unable to draw conclusions in relation to these interventions.
The findings suggest interventions relating to hospital nurse staffing models may improve some patient outcomes, particularly the addition of specialist nursing and specialist support roles to the nursing workforce. Interventions relating to hospital nurse staffing models may also improve staff-related outcomes, particularly the introduction of primary nursing and self-scheduling. However, these findings should be treated with extreme caution due to the limited evidence available from the research conducted to date.
This paper is a report of a study of nurses' perceptions of individualized care, the factors associated with these perceptions, and nurses' perceptions of the provision of individualized care in different types of healthcare organization.
Although individualized care has been an internationally-challenging and long-standing research topic in nursing, the current literature on individualized care from the perspective of nurses is limited.
A cross-sectional, descriptive and exploratory design using a questionnaire (Individualised Care Scale-Nurse) was employed to survey a stratified sample of 544 nurses (response rate 59%) working as Registered or Enrolled Nurses in one hospital district in Finland in 2008. Data were analysed using descriptive and inferential statistics (General Linear Model, one-way analysis of variance) and Cronbach's alpha coefficients for reliability analysis.
Nurses perceived that they supported patient individuality well and that the care they provided took into account patient individuality. Based on the General Linear Model, nurses' background variables were not associated with their perceptions of individualized care delivery. However, between-organization differences were found in all study variables: mental health ward nurses had the most positive perceptions, and nurses working in primary health centre long-term care wards the lowest.
Healthcare organizations and work environments need to be evaluated as they may have an influence on individualized care provision. The Individualised Care Nurse instrument is sensitive to healthcare working environments and can be used in evaluating nurses' perceptions of individualized care.
To evaluate the effectiveness of an individualized Cognition-Action (CA) intervention to reduce behavioral disturbances in severely deconditioned institutionalized old adults.
12 weeks randomized pilot trial of either individualized Cognition-Action program (n = 24) or routine medical care as control (C, n = 25).
Long-term care (LTC) of the Geriatric Department from the University State Hospital in Bordeaux, France.
49 institutionalized old patients with at least one Neuropsychiatric symptoms > or =4.
The CA rationale was a non-preconceived ideas approach over the patient's abilities and discourse. Patients received short bouts of 5-15 min and accumulated 50 min of interaction per week. CA intervention used five standardized exercises as tools to enhance communication and social interactions. CA was compared to usual care.
Primary outcomes were the Neuropsychiatric inventory (NPI) total and symptoms scores. Secondary outcomes were the BERG balance scale, the Geriatric Depression Scale (GDS), Quality of life AM-PAC-CAT and Muscle strength.
The CA group had a clinically significant NPI total score reduction compared to C, -7, 95%CI [-10.8 to -3], eta2 = 0.24. CA group showed a risk reduction of NPI total score worsening, OR = 0.09, 95%CI [0.02-0.37]. BERG total score was clinically improved in the CA group compared to C, 4.9 95%CI [0.7-9.2], eta2(p)= 0.11. CA patients reduced their GDS score and improved their Quality of life and Strength.
The combination of tailored guidance and simple standardized exercises was an effective behavioral management approach for behavioral disturbances reduction and functional autonomy improvement in institutionalized old adult populations.
We examined the short-term efficacy of two treatments using environmental supports (e.g. signs, alarms, pill containers, and checklists) to improve target behaviors in individuals with schizophrenia. 120 participants were randomized into one of the following three treatment groups: 1) Cognitive Adaptation Training (CAT; a manual-driven set of environmental supports customized to individual cognitive impairments and behaviors, and established and maintained in participants' homes on weekly visits; 2) Generic Environmental Supports (GES; a generic set of supports given to patients at a routine clinic visit and replaced on a monthly basis); and 3) treatment as usual (TAU; standard follow-up provided by a community mental health center). Global level of functional outcome and target behaviors, including orientation, grooming and hygiene, and medication adherence, were assessed at baseline and 3 months. Results of an analysis of covariance indicated that patients in both CAT and GES had better scores on global functional outcome at 3 months than those in TAU. Results of Chi Square analyses indicated that patients in CAT were more likely to improve on target behaviors, including orientation, hygiene, and medication adherence, than those in GES. Irrespective of treatment group, individuals who were high utilizers of environmental supports were more likely to improve on target behaviors than individuals who were low utilizers of supports.
We examined the effectiveness of an integrated supported employment (ISE) program, which augments Individual Placement & Support (IPS) with social skills training (SST) in helping individuals with SMI achieve and maintain employment. A total of 163 participants were randomly assigned to three vocational rehabilitation programs: ISE, IPS, and traditional vocational rehabilitation (TVR). After fifteen months of services, ISE participants had significantly higher employment rates (78.8%) and longer job tenures (23.84 weeks) when compared with IPS and TVR participants. IPS participants demonstrated better vocational outcomes than TVR participants. The findings suggested that ISE enhances the outcomes of supported employment, endorsing the value of SST in vocational rehabilitation.
This paper describes the development and evaluation of a brief, multidimensional, self-administered, social support survey that was developed for patients in the Medical Outcomes Study (MOS), a two-year study of patients with chronic conditions. This survey was designed to be comprehensive in terms of recent thinking about the various dimensions of social support. In addition, it was designed to be distinct from other related measures. We present a summary of the major conceptual issues considered when choosing items for the social support battery, describe the items, and present findings based on data from 2987 patients (ages 18 and older). Multitrait scaling analyses supported the dimensionality of four functional support scales (emotional/informational, tangible, affectionate, and positive social interaction) and the construction of an overall functional social support index. These support measures are distinct from structural measures of social support and from related health measures. They are reliable (all Alphas greater than 0.91), and are fairly stable over time. Selected construct validity hypotheses were supported.
This study was set up to test the effectiveness of primary nursing on the burnout level of psychiatric nurses. It was expected that, under certain conditions, such as a primary nursing care delivery with an adequate feedback system, the burnout level would decrease. In a quasi-experimental research design, a cohort of 161 psychiatric nurses was followed for 2.5 years. Results showed that although the burnout level did not change as a result of primary nursing, psychiatric nurses and the practical nurses seemed able to work according to the principles of primary nursing. Strong indications were found that the job turnover decreased as a result of the introduction of primary nursing. Because two main problems were encountered in this study, a high drop-out due to job turnover among nurses and the imitation of the intervention by the control group, several additional analyses were performed.
Interpersonal competencies of nurses are key to assisting patients in the work necessary for regaining health and well-being. Peplau's theory of interpersonal relations is detailed, and examples are given of the three phases which occur in developing nurse-patient relationships, along with associated challenges.
Individualized care is a total system of care that is tailored to a child with severely maladjusted behavior. The services are unconditional, flexible, child and family focused, and interagency coordinated. The services follow the child until the child is adjusting in a normalized, mainstream environment. Individualized care is illustrated through two different projects. One is the Alaska Youth Initiative where individualized care was used to return children from out-of-state, residential programs. The other is Project Wraparound where it was used to prevent children from being removed from their families. This paper begins with the principles of individualized care and then describes the ecological, multilevel assessment process that coincides with the delivery of services. A case example from Project Wraparound is provided for clarification. Following the case example is a discussion of the need for evaluation data with some suggested strategies for documenting effectiveness. The final section focuses on two barriers to the implementation of individualized care. One is the tendency to think in terms of component programs rather than individualized services. The other barrier is the competition for scarce resources. Strategies are presented for overcoming both barriers.
To present a new measure of community integration, the Community Integration Measure (CIM), and to offer preliminary information about its psychometric properties.
Validation study.
Community.
Ninety-two participants placed in 3 subgroups (brain injury survivors, n = 41; significant others, n = 36; college students, n = 15).
The distributional properties, factor structure, internal consistency reliability, content validity, discriminant validity, concurrent validity, and construct validity of the CIM.
All items correlated positively with each other and with the total score. Principal components factor analysis confirmed a 1-factor structure, which explained 44.1% of the variance. Internal consistency reliability, using Cronbach's alpha, was.87. Content validity was assured by the development procedure, correspondence with the theoretical model, and direct use of consumer language. Discriminant validity was supported by the CIM's ability to differentiate between subsamples. Criterion validity was supported by using correlations with the Community Integration Questionnaire. Construct validity was supported by correlations with the Interpersonal Support Evaluation List.
The CIM offers a brief, easily administered measure of community integration that conforms to an empirically derived theoretical model and is psychometrically sound.
The value of a primary nursing care delivery structure remains undecided. This study was carried out on an acute psychiatric admissions unit as it changed its care delivery system to that of primary nursing. A review of the literature highlights the inconclusive nature of previous investigations. The principle of evidence-based practice raises the need for further research to put this issue to rest. The staff perception of this change on both the atmosphere of the ward and on the role of the nurses themselves was analysed. A general reduction in satisfaction with role was discovered, as was a reduction in eight out of 10 subscales of the Ward Atmosphere Scale (Moos 1989). As primary nursing generally receives favourable reviews by nurses, and was in fact positively received by the staff in this study at the time of initiation, this negative result is surprising. It is conjectured that primary nursing may be an ideal philosophy of nursing that is difficult to realize due to constraints surrounding contemporary nursing practice.
Ways of working on acute psychiatric units have come under intense scrutiny in order for service users to receive modern care and treatment. This has led to various ways not only to improve the therapeutic milieu on psychiatric wards, but also to develop standardized approaches to care. This paper reports on a study on the development of a care pathway for people diagnosed with schizophrenia, with the aim of standardizing the care process. Action research was used to develop the care pathway and views were collected, and observations made from a range of mental health professionals. Not all respondents were in agreement with a care pathway and this led to clinicians defending the individualized nature of psychiatric care. Implementation of a care pathway may help not only to rekindle the therapeutic purpose of psychiatric care, but also to build in the individualized approach to carrying out hospital care. Limitations of the study have also been briefly reported.
Nurse job satisfaction was identified as an outcome measure for a project to develop and implement a patient care delivery model in an acute psychiatric setting.
Seventy registered nurses were surveyed during 3 years, utilizing the Index of Work Satisfaction.
Nurse job satisfaction has improved significantly (14%) since model development began. Analysis of variance showed significant (p < .05) increases in all component mean scores in the second and third surveys.
The relationship-based nursing model empowers nurses who know the patient best to decide how to provide care. It affirms the values that are the foundation of nursing practice, creating an environment where nurses feel they make a difference.
Healthcare professionals must find ways to accelerate the diffusion of knowledge within their organizations. Although nurses have extraordinary access to patient care data, they may underestimate their roles as data managers and innovators of change, and relinquish control of data to others. The authors discuss how nurses at an acute psychiatric hospital collect and report their own data to show the direct relationship between outcomes and excellence in nursing practice. Knowledge that is gained through practice is shared to inspire and sustain needed changes.
The practice of primary nursing
- M Manthey
Improved patient awareness of named nursing through audit
- N Shebini
- R Aggarwal
- A Gandhi
Ward atmosphere scale manual. Palo Alto: Consulting Psychologists
- R H Moos
- RH Moos
Palo Alto: Consulting Psychologists
- C Maslach
- S E Jackson