Power to the voice hearer - The German version of the voice power differential scale.

Voice power is an important concept in daily life of voice hearers and in the support and therapy for voice hearers who seek help. Therefore, the ability to examine voice power differentials between a voice and a voice hearer is essential. The present study aimed to collect data on voice power differentials and to further validate the Voice Power Differential Scale (VPD). 105 participants aged ≥ 18 with an ICD10 F2-diagnosis that included hearing voices were included in this study. Internal consistency was good (alpha = 0.792), as well as test-retest-reliability (r = 0.855) and correlations with other constructs were generally as expected. The VPD questionnaire results correlated negatively with the Beliefs About Voices Questionnaire-Revised's (BAVQ-R) items of Benevolence and Engagement-emotion. It correlated positively with Omnipotence and Resistance-emotion, as well as with Negative Content on the Psychotic Symptoms Rating-Scale (PSYRATS). Unexpectedly, no correlations were found with overall severity and command hallucinations. The Voice Power Differential Scale is an important tool for assessing and formulating a voice hearer's experience when they seek treatment or support for their verbal auditory hallucinations. The results of this study enrich the on-going discussion about the importance of voice power for voice hearers.

Seasonality in schizophrenia-An analysis of a nationwide registry with 110,735 hospital admissions.

BACKGROUND: Seasonal patterns in hospitalizations have been observed in various psychiatric disorders, however, it is unclear whether they also exist in schizophrenia. Previous studies found mixed results and those reporting the presence of seasonality differ regarding the characteristics of these patterns. Further, they are inconclusive whether sex is an influencing factor. The aim of this study was therefore to examine if seasonal patterns in hospitalizations can be found in schizophrenia, with special regard to a possible influence of sex, by using a large national dataset. METHODS: Data on all hospital admissions within Austria due to schizophrenia (F20.0-F20.6) for the time period of 2003-2016 were included. Age standardized monthly variation of hospitalization for women and men was analyzed and the level of significance adjusted for multiple testing. RESULTS: The database comprised of 110,735 admissions (59.6% men). Significant seasonal variations were found in the total sample with hospitalization peaks in January and June and a trough in December (p < 0.0001). No significant difference in these patterns was found between women and men with schizophrenia (p < 0.0001). CONCLUSION: Our study shows that schizophrenia-related hospitalizations follow a seasonal pattern in both men and women. The distribution of peaks might be influenced by photoperiod changes which trigger worsening of symptoms and lead to exacerbations in schizophrenia. Further research is necessary to identify underlying factors influencing seasonal patterns and to assess whether a subgroup of patients with schizophrenia is especially vulnerable to the impact of seasonal variations.

N-substituted tetrahydro-2,4-dioxoquinazolin-1-yl acetic acids as aldose reductase inhibitors.

Novel N-substituted tetrahydro-2,4-dioxoquinazolin-1-yl acetic acids characterized by formal replacement of the substituted benzyl moiety by cyclohexylmethyl and n-heptyl residues, respectively, were synthesized and evaluated as aldose reductase inhibitors.

Gender-gaps and glass ceilings: A survey of gender-specific publication trends in Psychiatry between 1994 and 2014.

BACKGROUND: Within academic psychiatry, women are underrepresented in the higher academic ranks. However, basic determinants of women's lack of academic advancement such as publication activity are poorly understood. The present study examines women's publication activity in high-impact psychiatry journals over two decades and reports developments in the numbers of male and female authorship over time and across cultural areas. METHODS: We conducted a retrospective bibliometric review of all articles published in 2004 and 2014 in three high-ranking general psychiatry journals. Statistical comparisons were made between the two years and with results from a baseline assessment in 1994. RESULTS: The overall percentage of female authors increased from 24.6% in 1994 to 33.2% in 2004 to 38.9% in 2014. Though increases in female authorship were statistically significant for both decades, there was less difference between 2004 and 2014, indicating a possible ceiling effect. Rates of female first authors increased between 1994 and 2014, though to a lesser degree between 2004 and 2014. Numbers of female corresponding authors plateaued between 2004 and 2014. Within Europe, Scandinavia displayed the most balanced gender-wise first author ratios. Western European and Central European countries increased their rates of female first authors substantially between 2004 and 2014. CONCLUSIONS: Despite gains in some areas, our study reveals considerable deficits in the diversity of the current academic psychiatric landscape. Ongoing efforts and interventions to enhance the participation of underrepresented groups on institutional, political and editorial levels are necessary to diversify psychiatric research.

[Implementation and evaluation of supportive approach of the psychiatric nurse specialist and psychiatric community health nurse. Part III]. / Die implementering en evaluering van 'n ondersteuningsbenadering deur 'n psigiatriese verpleegspesialis aan psigiatriese gemeenskapsverpleegkundiges. Deel III.

The psychiatric community nurse takes on the role of an expert in her interaction with the psychiatric patient and others because she feels unprepared to manage therapeutic interaction. She measures her own abilities against the patient's progress and this makes it important for therapeutic interaction to succeed. This is accomplished when she exercises control over the interaction, manipulates the interaction by describing or reformulating the negative experiences or meanings verbalised by patients. She also distances herself from the psychiatric patient by stigmatising the psychiatric patient or if she feels that she cannot solve the problem, she refers the psychiatric patient to an external resource. The above narration indicates that this action by the psychiatric community nurse is not facilitative for patient interaction. In order to facilitate patient interaction, a supportive approach was generated and described by Van Wyk (1995: 99-116) whereby the advanced psychiatric nurse (a person with a masters degree or an advanced diploma in psychiatric nursing), creates a context where the psychiatric community nurse can sacrifice her objective observing position for an observed position where she forms part of the story of interaction between herself and the psychiatric patient. The objective of this study was to describe the implementation and evaluation of Van Wyk's (1995: 99-116) supportive approach to the psychiatric community nurse in interaction with the psychiatric patient by utilizing multiple descriptive case studies.

Nursing service managers' views on problems they experience in their everyday lives: Part 1.

During 1994 it became clear to the health care delivery system management team of the old Transvaal region (Gauteng, North West and Eastern Transvaal) that nursing service managers in leadership positions were experiencing great strain in their daily work situation and seemed fatigued and stressed. The problem identified was that if nursing service managers themselves were fatigued and stressed, this would become an obstacle in the provision of quality health care. Assistance was requested to provide a support programme for the nursing service managers. Prior to developing and implementing the support programme it was necessary to explore and describe nursing service managers' views on the problems they were experiencing in their everyday lives (personal and professional) and to ascertain their specific needs for support. A qualitative, exploratory, descriptive and contextual research design was utilised in this research. A questionnaire with open-ended questions was used for gathering data. A purposive sample of one hundred nursing service managers was included in this research. Sixty of the one hundred questionnaires were completed. Data were analysed by a qualitative descriptive method of analysis. Four major categories regarding nursing service managers' experience of problems in their daily lives, were identified: difficulty in relationship with diverse others; lack of sufficient group acceptance/support; value conflicts, and difficulty with self-acceptance Conclusions and recommendations were made and limitations discussed.

Development and operation of a support programme for nursing service managers: Part 2.

This paper describes research conducted to develop and implement a support programme for nursing service managers suffering from fatigue. The support programme was developed on the basis of results obtained from a survey that ascertained nursing service managers' views about the problems they were experiencing in their everyday lives. A multiple case-study design was utilised to describe the operationalisation of the support programme. The sample consisted of forty-eight English speaking and fifty-two Afrikaans speaking nursing service managers from the old Transvaal region (Gauteng, North West and Eastern Transvaal. The support programme was implemented during two one-day workshops, one with the Afrikaans speaking group and one with the English speaking group of nursing service managers. Data were gathered about operationalisation of the support programme through multiple methods: observation, audiotape recordings, written documents and field notes. The data were analysed by utilising the methods of descriptive analysis. The results of the research were described by means of multiple descriptive case-studies, whereafter a cross-validation report, as described by Yinn (1989:52-57) was utilised to reflect commonalities and differences between the workshops. Conclusions and recommendations were made and limitations discussed.

Adolescents previously involved in Satanism experiencing mental health problems.

No research has previously been done regarding the phenomenon of adolescents who have previously been involved in Satanism and who experience obstacles in their strive for mental health. Adolescents previously involved in Satanism present behavioral problems like aggressive outbursts, depression, "psychosis" or suicide attempts, that could lead to suicide. In the phenomenon-analysis semi-structured, phenomenological interviews were performed with the respondents and their parents. The respondents were requested to write a naïve sketch about their life. After completion of the data-control, guidelines for nursing staff were set. The guidelines are set for the management of adolescents who have previously been involved in Satanism and who experience obstacles in their strive for mental health. Interviews with experts in Satanism were conducted, literature in the form of books, magazines and newspaper-clippings were used to verify the research findings. The most important guidelines are that the caregivers have to be reborn Christians; they are not allowed to show any fear or sympathy; they must have sufficient knowledge about Satanism; the adolescents have to be unconditionally accepted; the caregivers have to work in a team and the adolescents have to be taught to deal with their emotions.

[The phenomenon of families who are involved in decision making about life support withdrawal in family members]. / Die verskynsel van gesinne wat betrokke is by besluitneming oor onttrekking van lewensondersteunende behandeling.

The overall objective of this study was to explore and describe the phenomenon of families who are involved in deciding about withdrawal of life-support treatment of a family member. A phenomenon analysis was undertaken in two phases. During the first phase, secondary analysis of primary data was done on the family used in Burger's study (1996: 1-175) and was followed up by phenomenological interviews with families used as member checking from the same circumstances and according to the same criteria that Burger (1996: 1-185) used in her study. Data were analysed in collaboration with an independent coder. The family used as member checking in this study is also used as data control. A literature control was conducted as part of data control. The themes that were identified included were: physical and bodily experiences of families; defence mechanisms used by families to cope with grief; emotional experiences of families; need of knowledge/perceptions/outlook on life/internal conflict/feelings of guilt/ability to make decisions/respect of patient wishes/the effect of time and prior experiences; support needed by an given to families; spiritual and supernatural experiences/hope/acceptance/ability to 'let go' of the patient. In phase two, guidelines were described for psychiatric nurse specialists to mobilise resources for families to promote, maintain and restore their mental health as an integral part of health.

[Burnout among psychiatric nurses in a private, psychiatric hospital]. / Beroepsmatheidervaring by psigiatriese verpleegkundiges in 'n privaat psigiatriese hospitaal.

The purpose of this study was to explore and describe aspects which cause and promote burnout amongst psychiatric nurses. Participants were purposively selected and individual focus interviews were recorded on tape. Certain themes were identified during data analysis and based on that the following conclusion were reached: an external locus of control leads to feelings of "stuckness"; high personal standards lead to psychiatric nurses making themselves available in the work environment with subsequent negative effects on themselves; psychiatric nurses take too much responsibility and become indifferent or overly involved (co-dependent) due to vague boundaries leading to feelings of fatigue, apathy and loss of motivation; lack of support and a need of recognition in the work environment lead to emotional fatigue; a too heavy workload, staff shortage and an uncertainty regarding role description in the work environment leads to feelings of fatigue, negativity, "stuckness", anger and apathy.

The experience of HIV reactive patients in rural Malawi--Part I.

Malawi has a population of 9 million people with AIDS the leading cause of death in the 20-40 age group. The HIV positive prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994:1). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but patients who do not see the benefit of knowing their HIV status increasingly refuse testing. The counselling practise as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of the research study was to describe a model of counselling that would meet the needs of an AIDS patient in rural community in Malawi. A qualitative research design that was explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is explored as the other major factor in the phenomenon examined. One phase of the research is described in this article namely exploring and describing the experience of the HIV reactive patient in rural Malawi. Results show that patients are in an advanced stage of AIDS when they are diagnosed and complain of weakness and an inability to do work, including an inability to do their daily chores. This causes a feeling of desperateness that is worsened by the perception that support systems are inadequate. Support systems are mostly identified as parents, partners and siblings to assist mainly with the physical care and financial support. Despite the fact that the family is very important to patients there is a reluctance to acknowledge their HIV status. Patients fear being rejected once it is known that they have AIDS--not only because AIDS is a sexually transmitted disease, but also because it is perceived that financial and other support will be withheld if it is known that patients have AIDS and will therefore die and not be able to return the support provided. Patients feel they have no future once a diagnosis of AIDS has been made which results in refusal of testing, as they do not see the benefit of knowing their HIV status. Assessing the coping ability of the patient within the household as part of an overall assessment is one proposed strategy that could be taken. Secondly the patient is encouraged to take a more active role in the counselling process, which could be achieved by narration. The family should be incorporated into the counselling process as early as possible.

A care counselling model for HIV reactive patients in rural Malawi--Part II.

The purpose of the research conducted was to explore and describe HIV patients experience of their illness within the context of rural Malawi and, based on the results of the study, to describe a model for counselling HIV reactive patients in rural Malawi which would meet both the internal and external needs of the patient. Nursing for the Whole Person Theory, as well as symbolic interactionism and the research model of Botes, were used as paradigm, as the researcher believes a person is fundamentally a historical social being who can only be understood in a specific cultural context of space and time. The research was also conducted within a counselling context and different disciplines were integrated in the study. The research method followed two phases each addressing a different objective. Firstly, exploration and description of the HIV reactive individual's experience of illness, compilation of a demographic profile of the patients in the study and a description of their identified needs as well as possible resources, exploration and description of the primary care givers' experience of HIV reactive patients and the exploration and description of the viewpoint of counsellors in terms of counselling HIV reactive patients. In the first phase of the study in-depth phenomenological interviews were conducted with identified groups. Focus interviews were conducted with a hundred AIDS patients to identify the needs and resources of the patients and to compile a demographic profile. Focus groups discussions were conducted with counsellors for more complete comprehension. Data-analysis and literature control was undertaken. In the second phase of the study theory generation was used in order to develop a counselling model for AIDS patients and guidelines for implementing the model were generated. Based on the results of the analysis the major concept enable was identified as the essence of a model for counselling AIDS patients in rural Malawi. The visual model developed described a process of enablement with the counsellor as negotiator and the patient as a narrator in which the patient, family and community are encouraged to participate actively. By utilising the deductive reasoning strategy, relationship statements were inferred from the model. Guidelines were described for all three phases of the model, namely pretest counselling, post-test counselling and community care, in terms of objectives, strategies and activities. The value of this research was embodied in addressing a very real and urgent need in Malawi and proposing a solution with practical guidelines.

The promotion of mental health of adolescents in a township in Swaziland.

A number of adolescents have been observed drinking alcohol, pushing and abusing drugs and also stealing cars. A lot of adolescents idle in the township streets, girls are falling pregnant and dropping out of school. No research has been done to elicit the opinions of families on the everyday life of the adolescents in this township. The objectives of this research were twofold, namely. To explore and describe the families' opinions on the everyday life of adolescents in a specific township in Swaziland, and to describe guidelines for advanced psychiatric nurse practitioners to assist these families to mobilize resources in order to promote, maintain and restore mental health as integral part of health of adolescents in this township. A qualitative, exploratory, descriptive and contextual design was used where the research was conducted in two phases. Trustworthiness measures as well as ethical measures were applied throughout the research. Five categories were identified from the result of the focus group interviews with families: Adolescents presenting ineffective communication patterns due to lack of support from their families; adolescents engaging into risky lifestyles related to lack of support and healthy relationship with their parents; families unable to create a supportive and conducive environment for their adolescents due to their focus on own family stumbling blocks and non-availability of recreational centres related to lack of a supportive and conducive environment in the community and inadequate accommodation leading to overcrowding. Guidelines for advanced psychiatric nurse practitioners were deducted from identified themes and the literature control.

[Adolescents previously involved in Satanism: mental health problems experience]. / Adolessente betrokke by Satanisme: wat geestesgesondheidsprobleme ondervind.

As far as the phenomena of adolescents previously involved with satanism that experience obstacles in the strive for mental health, no research has previously been done. Adolescents previously involved in satanism, presents behaviour problems like aggressive outbursts depression, "psychosis", or suicide attempts that can even lead to suicide. In the phenomena-analysis semi-structured, phenomenological interviews with the respondents and their parents, were performed. The respondents were requested to write a naive sketch about there life. After the data-control was done, guidelines for nursing staff had been set. The guidelines are set for the management of adolescents that has previously been involved in satanism, and experiences obstacles in their strive for mental health. Interviews with experts in satanism was done, literature in the form of books, magazines and newsclippings were used to verify the findings in the research. The most important guidelines are that: the caregivers have to be reborn Christians; they are not allowed to show, any fear or sympathy; they have to have sufficient knowledge about satanism; the adolescent has to be unconditionally accepted; the caregivers have to work in a team; the adolescents have to be taught to deal with their emotions.

The experience of mothers caring for their teenage daughters' young children.

The purpose of this study was firstly to explore and describe the experiences of mothers who are looking after their teenage daughters' young children. Secondly, to formulate guidelines (based on the results obtained) for psychiatric nurses in assisting these mothers to mobilise resources in order to promote, maintain and restore their mental health as an integral part of health. An exploratory, descriptive, contextual and qualitative design was used and Guba's model for ensuring trustworthiness in qualitative research was applied. The phenomenological approach was used to collect and analyse data from a sample of seven respondents who were purposively selected. Three independent themes emerged from the analysis of results: Meaning of the parenting role, life-style changes and support systems. The results further show that for these mothers the problem of teenage pregnancy and parenthood ends up being their problem. Their experiences in looking after these babies, although sometimes fulfilling and meaningful, are most of the time stressful. This has implications on their mental health. Guidelines are recommended in order to facilitate these mothers to mobilise their resources for mental health.

A model for culture-congruent psychiatric nursing.

The purpose of the research conducted was to explore and describe the influence of culture on approaches to mental illness and the patients' compliance with psychiatric treatment, and to generate a practice model for culture-congruent psychiatric nursing from which guidelines were described. The Nursing for the Whole Person Theory was used as the paradigm. The research method followed three phases--each addressing a different objective. Firstly, explanatory, descriptive research was conducted to compile explanatory case studies reflecting cultural approaches to mental illness and the patients' compliance with psychiatric treatment. The sample consisted of four psychiatric patients purposively selected from four long-term wards of a psychiatric hospital, a group of psychiatric nurses, and the psychiatrists treating each of these patients based on information obtained from the semi-structured interviews, field notes and the patients' clinical documents. From the results of the case studies a practice model for culture-congruent psychiatric nursing was generated using Chinn and Kramer's approach as framework and the major concept "negotiation". Guidelines for a culture-congruent approach in psychiatric nursing were compiled from the model using deductive reasoning and analysis.

[The psychiatric health model for meaningful support by family members who must decide on the treatment of life support]. / 'N geestesgesondheidsmodel vir ondersteuning van gesinslede wat moet besluit oor die onttrekking van lewensondersteunende behandeling.

The aim of this research is to develop, describe, operationalize and evaluate a model as framework for meaningful support by the advanced psychiatric nurse, which will serve to support family members who are involved in the decision-making process regarding the withdrawal of life sustaining treatment, in order to promote their mental health. The paradigm of the Department of Nursing of the Rand Afrikaans University, which endorses the Theory for Health Improvement in Nursing (Randse Afrikaanse Universiteit: Departement Verpleegkunde, 200: 1-16) was accepted for the purpose of this research. A theory generating design which is qualitative, descriptive and contextual was used to develop the model as framework of reference for meaningful support. Step one identifies, classifies and defines the central concept "meaningful support", as well as the essential and relative concepts. Step two formulates the inter-relational views of the identified and defined concepts. In step three the guidelines of Chinn & Kramer (1995: 105-124) was utilised for the structural and process description of the model. The structure of the model's process, which comprises three phases, is cyclic. Step four consists of evaluation regarding the process description of the model, done according to the definition of the central concept "meaningful support". The evaluation criteria of Chinn & Kramer (1995: 125-135) were also used.

One voice regarding the legalisation of abortion. Nurses who experience discomfort.

The legalisation of abortion has been implemented since February, 1997. No research has been conducted on the effects of abortion on nurses. The objectives of this project were: 1. to explore and describe nurses' experience of abortion, and 2. to describe guidelines to support nurses. A qualitative, explorative, descriptive and contextual research design was used. The research was conducted in two phases, i.e., the exploration of nurses' experience, and description of guidelines. Trustworthiness measures as well as ethical measures were applied. Five themes were identified from the result of the interviews with nurses: freedom of choice of nurses to provide support; negative perceptions regarding the women who requested the abortion and staff providing the abortion; need for information; turmoil regarding life versus death, and recommendations from nurses regarding the management of abortion. Guidelines to support nurses were deducted from the identified themes.

[Support for the psychiatric nurse specialist and the psychiatric community nurse in their interactions with the psychiatric patient. Part II]. / Ondersteuningsbenadering aan psigiatriese gemeenskapsverpleegkundiges in interaksie met psigiatriese pasiënte. Deel II.

In this article the research is described that had as goal to generate a supportive approach for the psychiatric nurse specialist to the psychiatric community nurse in interaction with the psychiatric patient, to promote, maintain and restore their mental health as an integral part of health. Guidelines for operationalisation of this supportive approach by the psychiatric nurse specialist, are also described. The research design utilised a qualitative, descriptive and contextual design. The exploratory field work was done in phase one of this research (as described in part I of these articles) and consisted of phenomenological interviews and focus groups. Trustworthiness was ensured by utilising Guba's model for trustworthiness.