Mental Health Nurses' Perceptions of Their Role in Physical Screening and Lifestyle Coaching for Patients With a Severe Mental Illness: A Qualitative Study.

BACKGROUND: The life expectancy of patients with severe mental illness (SMI) is estimated to be 20 to 30 years shorter than in the general population due to avoidable physical illnesses. This gap is widening. Health care professionals' performance with regard to physical health and lifestyle appears to be suboptimal. AIMS: The purpose of this study is to formulate recommendations to enhance physical care for patients with an SMI. METHODS: A generic descriptive qualitative study was conducted. Fifteen mental health nurses (MHNs) working in community mental health care in the Netherlands were interviewed. Thematic analysis of the data was performed. RESULTS: Most MHNs perceived physical screening and lifestyle interventions to be an important part of their professional role. However, they recognize discrepancy between their perception and actual practice. Most MHNs focus in particular on the psychiatric illness and its consequences for daily living, and they defined the provision of physical health care as a secondary concern. Participants described building a therapeutic relationship as a crucial, however, difficult part of the process of working on physical health promotion. Many MHNs tend to formulate goals and necessary behavioral changes on behalf of their patients, rather than helping them formulate their own goals and activities for themselves. CONCLUSIONS: Building a good therapeutic relationship with patients and supporting patients in defining their own lifestyle goals can enhance nursing physical care. Support by other team members (such as NPs) and managers is needed. In training and education for professionals, the lessons learned in this study should be included.

Postdoctoral Nurses' Experiences With Leadership and Career Development: A Qualitative Study.

PURPOSE: The purpose of this study was to explore the experiences and perceptions of Dutch postdoctoral nurses working in research with leadership and career development. METHODS AND DESIGN: A generic explorative qualitative design with semistructured in-depth interviews was used. A criterion sample of 13 postdoctoral nurses working in research in the Netherlands was included. The data were analyzed using thematic analysis. FINDINGS: Three themes were identified: (a) developing leadership and identity as a PhD nurse, (b) becoming a valuable member in the scientific world of academe, and (c) continuous search for progression while balancing worlds and tasks. Postdoctoral nurses experienced their leadership and professional development as a serious and conscious process. Their vision of nursing, health care, and research was an important motive regarding future career choices. Although the scientific world of academe was perceived as honorable, the nurses experienced it as a complex work environment. All the postdoctoral nurses had to deal with the demands and pressures of the scientific world. Coping with the tension between enjoying work and handling high workloads and academic achievements was described as challenging. Searching for balance was important, especially because of the different part-time employment or working activities with various commitments. CONCLUSIONS: This study demonstrates that postdoctoral nurses do show considerable progression in their leadership and career development; however, they experience the scientific working environment as challenging. The findings of this study indicate the need for more academic positions, the strengthening of the infrastructure for nursing research, and the development of supportive leadership and mentoring programs for postdoctoral nurses to provide optimal evidence-based and high-quality care for patients. CLINICAL RELEVANCE: Postdoctoral nurses need to develop strong leadership competencies to strengthen research, education, and evidence-based practice in clinical care to improve patient and healthcare outcomes.

Parental Presence and Activities in a Dutch Neonatal Intensive Care Unit: An Observational Study.

The presence of parents during a neonatal intensive care unit (NICU) admission is important for the well-being of both infants and their parents. Therefore, the aim of this study was to identify parental presence in terms of frequency, duration, and activities in the NICU in relation to characteristics of both infants and parents. An observational study was performed in a Dutch level III NICU. All infants admitted for more than 24 hours were included. One hundred sixty-two infants were included. For a median duration of 3 to 4 hours a day, at least one of the parents was present. After the first week after birth, 80% of both parents participated in the care of their infant. A vaginal delivery, longer duration of kangaroo care, higher birth weight, bronchopulmonary dysplasia, being a first child, the second and following admission week(s) after birth, and a short driving distance led to a significantly longer duration of presence for both parents. Mothers were present for a significantly longer duration of time than fathers (P = .00). It is recommended that public and employer policies, as well as physical conditions and necessary facilities, in the NICU be examined for their support of parental presence.

Development of a Video-feedback Intervention to promote Positive Parenting for Children with Autism (VIPP-AUTI).

In this paper we describe the development and content of Video-feedback Intervention to promote Positive Parenting for Children with Autism (VIPP-AUTI). VIPP-AUTI is an adapted version of the evidence-based intervention VIPP. The lack of social responsiveness in children with autism often lowers the quality of the parent-child interaction. A wide range of early interventions exist to cope with the disorder. The majority of early interventions for children with autism focus on their deficits of (social) skills, but the number of evidence-based interventions to improve early parent-child interaction patterns is limited. The aim of VIPP-AUTI is to enhance parental sensitivity to children's autistic characteristics, in order to improve child developmental outcome by increased parental support.

Parental reaction to early diagnosis of their children's autism spectrum disorder: an exploratory study.

This study explores parental reactions subsequent to receiving their child's autism spectrum disorder (ASD)-diagnosis. Seventy seven parents of recently diagnosed children participated in the Reaction to Diagnosis Interview. Within this group, associations between parental reaction to diagnosis, parental and child characteristics and prediagnostic circumstances were analysed. In a sub-sample, the stability of reaction to diagnosis was examined. The majority of parents were classified as 'resolved' regarding their child's diagnosis. Conversely, parents of children with more severe ASD symptoms or non-Dutch parents were more likely to be classified as 'unresolved'. Sub-sample analysis revealed stability of reaction to ASD-diagnosis. The majority of parents adapted well to the circumstances and the care for their child. Autism severity and parental nationality were significant factors affecting parental reactions. Thus, early identification of parental reaction to children's ASD-diagnosis may aid in providing more tailored parental support programs.

Factors influencing motivation of patients diagnosed with depression to have electroconvulsive therapy.

WHAT IS KNOWN ON THE SUBJECT?: The clinical effect of electroconvulsive therapy (ECT) has been confirmed for a majority of patients with several psychiatric disorders. ECT is mostly used in patients with severe depression. Choosing, persevering with and completing ECT depends on the patients' motivation for undergoing this therapy. However, the factors influencing patients' motivation for ECT have not yet been studied. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Four important factors that influence the motivation of patients diagnosed with major depression to have ECT were identified: (1) psychological pain and distress; (2) perceived need for treatment; (3) perception of ECT as an effective treatment; (4) influence of the environment. The first factor, psychological pain and distress, was perceived as the primary motivator for starting and continuing ECT. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professionals should be aware of the factors that influence patients to have electroconvulsive therapy and their own role in the decision-making process and during treatment. As patients are susceptible to emotional support and as the motivation of patients for starting and continuing ECT is positively influenced by the advice and support of mental health professionals, these professionals have a key role in motivating patients for ECT. When the patient has decided to start ECT, mental health professionals should explore the factors that influence their motivation and regularly assess these factors so that they can guide the patient in their process. The professional should have an overview of these factors and investigate how they can be positively influenced to help patients keep their motivation during the treatment process. This will contribute to person-centred care and could lead to better treatment outcomes. ABSTRACT: Introduction The factors influencing patients' motivation for undergoing electroconvulsive therapy (ECT) have not yet been subjected to a thorough study. Knowledge of these factors could improve the quality of care for patients with depression recommended to have ECT. Aim To identify the factors that influence the motivation of patients diagnosed with depression to have ECT. Method This qualitative study followed a grounded theory approach in which semi-structured interviews were conducted with 18 patients from four different psychiatric hospitals to study their perspectives on factors influencing their motivation to have ECT. Results The explanatory framework of factors influencing motivation for ECT comprises four main categories, starting with the most important category, psychological pain and distress, and continuing with the following categories: perceived need for treatment; perception of ECT as an effective treatment; environmental influences. Discussion In this study, we found that the psychological pain and distress of depression, and their consequences in daily life, had been the primary experiences that motivated patients to start and continue ECT. Implications for Practice This is the first study that has examined motivational factors for patients with severe depression to participate in ECT. Professionals appear to have a key role in motivating patients for ECT. They should explore factors that influence motivation for ECT, regularly assess their motivation and intervene on influential factors.

A systematic review of nursing rehabilitation of stroke patients with aphasia.

AIM AND OBJECTIVES: To explore the evidence on rehabilitation of stroke patients with aphasia in relation to nursing care, focusing on the following themes: (1) the identification of aphasia, (2) the effectiveness of speech-language interventions. BACKGROUND: Patients with poststroke aphasia have higher mortality rates and worse functional outcome than patients without aphasia. Nurses are well aware of aphasia and the associated problems for patients with stroke because they have daily contact with them. The challenge is to provide evidence-based care directed at the aphasia. Although rehabilitation stroke guidelines are available, they do not address the caregiving of nurses to patients with aphasia. DESIGN: Systematic review. METHOD: Published studies were reviewed, focusing on identification and treatment of aphasic patients after stroke in terms of the consequences for nursing care. Also, data concerning effective speech-language interventions were extrapolated into nursing practice with respect to the classification of nursing interventions. RESULTS: Intensive speech-language therapy, which was initiated in the acute stage post stroke, showed the best rehabilitation outcomes. Trained persons other than speech-language therapists provided effective speech-language interventions. Speech-language therapy included several types of intervention that met nursing intervention classifications. CONCLUSION: The contribution of nursing to the rehabilitation of patients with aphasia is relevant. The use of screening instruments by nurses can increase early detection of aphasia, a precondition for initiating timely speech-language therapy. Collaboration between speech-language therapists and nurses is of the utmost importance for increasing the intensity and functionality of speech-language exercises, which may enhance the quality of treatment. RELEVANCE TO CLINICAL PRACTICE: The findings of this study can be used to develop nursing rehabilitation guidelines for stroke patients with aphasia. Further research is necessary to explore the feasibility of using such guidelines in clinical nursing practice and to examine the experiences of patients with nursing interventions directed at aphasia.

Patient experiences with nursing care during hospitalization on a closed ward due to a manic episode: A qualitative study.

PURPOSE: To describe the experiences of patients with nursing care they had received when hospitalized for mania. DESIGN AND METHODS: Multicenter qualitative study using open interviews. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: Sense of security is vital for the recovery of these patients, nurses can support and hinder this. Feelings of security are related to clear and calm communication, respect, recognizability of nurses, and daily structure. PRACTICE IMPLICATIONS: Nurses should make sure that the patient recognizes them as nurses. Nurses should spend as much time as possible in the living room. Clear communication about treatment goals is important.

Nursing interventions for patients with postpartum psychosis hospitalized in a psychiatric mother-baby unit: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT: If women suffer from postpartum psychosis, treatment in a specialist facility like a psychiatric mother-baby unit is recommended and should focus on the maternal health, mother-baby outcomes and the care for the next of kin. The role of mental health nurses on a mother-baby unit is essential but challenging, given the complex problems and care needs of the patient, the baby and family members. To date, very little evidence about effective nursing interventions for patients with postpartum psychosis is available. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This paper systematically describes nursing interventions and their rationale for patients with postpartum psychosis admitted to a specialized mother-baby unit. Given the limited scientific evidence for effective nursing interventions for patients with postpartum psychosis, knowledge was obtained from a best-practice setting (i.e., a specialized mother-baby unit), thus providing a basis for the systematic development of nursing interventions to be tested on effectiveness in future studies. IMPLICATIONS FOR MENTAL HEALTH NURSING: Mental health nurses play an essential role in the multidisciplinary treatment team in providing information on the patient's personal functioning and her ability to take care for the baby, in order to determine the appropriate amount of guidance and protection, in order to prevent harm and promote recovery. To provide integrated and personalized nursing care, mental health nurses should tailor their interventions to the needs of the patient, the baby and the next of kin, adapted to the successive stages of treatment. Abstract Introduction Postpartum psychosis is one of the severest psychiatric disorders to occur in the postpartum period. If it requires a woman's admission, a psychiatric mother-baby unit is recommended, where care will focus on the mother's health, the mother-baby dyad and their next of kin. To date, few studies have examined nursing interventions for patients with postpartum psychosis. Aim Identifying nursing interventions used at a psychiatric mother-baby unit, when a patient is hospitalized with postpartum psychosis. Method A qualitative design using thematic analysis. Data were collected using semi-structured interviews (N = 13) with expert nurses working at such a unit. Results The analysis identified three themes: (a) treatment of the mental disorder, which involves interventions to improve the mother's mental and physical well-being; (b) care for the mother-baby dyad, which involves interventions intended to promote safe interactions between mother and baby; and (c) care for the partner, which involves interventions to improve the partner's well-being. Discussion Overall, within each of these themes, nurses described the urgency to tailor interventions to the needs of the patient, baby and partner. Implications to practice Our comprehensive description of interventions can be used for the improvement of nursing care for patients hospitalized with postpartum psychosis.

Peripheral intravenous cannulation: complication rates in the neonatal population: a multicenter observational study.

INTRODUCTION: Neonates admitted to a neonatal intensive care unit (NICU) rely highly on intravenous (IV) therapy, for which the peripheral intravenous cannula (PIVC) is the preferred device to allow such therapies to proceed. Placement of a PIVC is a painful procedure and repeated attempts for successful insertion should therefore be limited. We aimed to quantify the incidence, complications, and factors associated with these complications. METHODS: We conducted a prospective observational study to examine PIVC-related complications in level III NICUs of two university medical centers (UMC) in The Netherlands. We performed descriptive analyses and binary logistic regression analysis to identify factors associated with PIVC complications. RESULTS: A total of 518 catheters were inserted in 235 infants. The first-time success rate was 45%. The predominant reason for non-elective removal due to complications was infiltration (N = 193; 67%). No significant association was found between discipline of the inserter, vein visualization device and location of the PIVC and whether or not a catheter needed to be removed due to a complication. CONCLUSIONS: In this study the majority of PIVCs were removed after the occurrence of a complication. The most common complication was infiltration. Strategies to identify and prevent infiltration in an NICU population are required. Future interventional studies should attempt to improve first-time insertion success and reduce PIVC failure from infiltration in the neonate. Based on the results of the present study, neonatologists and physician assistants are the preferential PIVC inserters. Advanced training of all members of vascular access specialist teams and ongoing monitoring of PIVC-related complications are recommended.

Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial.

In a randomized controlled trial, we evaluated the early intervention program Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI) with 78 primary caregivers and their child (16-61 months) with Autism Spectrum Disorder. VIPP-AUTI is a brief attachment-based intervention program, focusing on improving parent-child interaction and reducing the child's individual Autism Spectrum Disorder-related symptomatology in five home visits. VIPP-AUTI, as compared with usual care, demonstrated efficacy in reducing parental intrusiveness. Moreover, parents who received VIPP-AUTI showed increased feelings of self-efficacy in child rearing. No significant group differences were found on other aspects of parent-child interaction or on child play behavior. At 3-months follow-up, intervention effects were found on child-initiated joint attention skills, not mediated by intervention effects on parenting. Implementation of VIPP-AUTI in clinical practice is facilitated by the use of a detailed manual and a relatively brief training of interveners.

Brief report: oxytocin enhances paternal sensitivity to a child with autism: a double-blind within-subject experiment with intranasally administered oxytocin.

Oxytocin seems associated with parenting style, and experimental work showed positive effects of intranasally administered oxytocin on parenting style of fathers. Here, the first double-blind, placebo-controlled, within-subject experiment with intranasal oxytocin administration to fathers of children with autism spectrum disorder (ASD) is presented. Fathers with their typically developing toddler (n = 18), and fathers of toddlers diagnosed with ASD (n = 14), were observed in two play sessions of 15 min each with an intervening period of 1 week. In all fathers oxytocin elevated the quality of paternal sensitive play: fathers stimulated their child in a more optimal way, and they showed less hostility which suggests the positive effects of oxytocin on paternal sensitive play irrespective of clinical status of their child.

Caregiver burden in bipolar hypomania and mania: a systematic review.

PURPOSE: Bipolar mania is characterized by marked impairment in social, occupational, or other important areas of functioning. One should expect to see an equally severe burden in informal caregivers. The literature was reviewed in order to provide a foundation upon which to build nursing interventions. CONCLUSIONS: Several characteristics of bipolar mania-patient aggressiveness, lack of insight, and financial problems-were identified as severe burdens to caregivers. Professionals might not have a total view of the extent of the burden in caregivers. This review could not link the patients' mania or hypomania to factors that were described in other literature on caregiver burden related to bipolar disorder, regardless of the type of episode. PRACTICE IMPLICATIONS: There is a need for further research in this area to make more explicit the burden on caregivers during times of mania or hypomania.