Service user involvement in a secure setting before and after the implementation of recovery-oriented practice: A quasi-experimental study.

AIM: To measure change in service user involvement in secure mental health units, before and after the implementation of recovery-oriented practice. DESIGN: Quasi-experimental study pretest-posttest design with non-equivalent comparison groups. METHODS: Data were collected from May 2018 to December 2019 in four medium-/high-security units in Norway. Two intervention units that implemented recovery-oriented practice were compared with two comparison units that did not. Data were obtained using anonymous questionnaires at baseline and at 6-month follow-up. For intervention units, data were also obtained at a 12-month follow-up to measure sustainability of improvements over time. Twenty inpatients ('patients'; intervention group: 10, comparison group: 10) and 141 members of frontline staff ('service providers'; intervention group: 92, comparison group: 49) participated at baseline. Mann-Whitney U-tests and independent sample t-tests were applied at the group-level to analyse changes in mean scores in groups. RESULTS: Among patients in the intervention units, findings indicated no improvements after 6 months, but significant improvements after 12 months in terms of patients' opportunities to participate in formulating their individual care plans, to influence decision-making about therapy and to receive information about complaint procedures. Opportunities to participate in discussions about medication and treatment regimens did not improve. After 6 months, service providers in the intervention units reported an increase in democratic patient involvement, patient collaboration and management support, but not in carer involvement and assisted patient involvement. The improvements in democratic patient involvement and management support were sustained over time. No changes were found in the comparison groups. CONCLUSION: The patients and the service providers reported a higher degree of service user involvement after implementing recovery-oriented practice. Specific work is needed to ensure patients' involvement in all domains. IMPACT: The findings are encouraging with respect to the potential to increase empowerment in a restricted setting through the implementation of recovery-oriented practice.

Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward.

BACKGROUND: Contextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patients' perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward. METHODS: During a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents. RESULTS: A substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward. CONCLUSIONS: Findings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.

Improving social network support for partners facing spousal cancer while caring for minors: Four-month outcomes of a single-centre randomised controlled trial.

Social support is an important predictor of the well-being of partners of cancer patients. Those who are caring for minors (well parents) may be in special need of such support. The aim of this study was to evaluate the 4-month impact of a psychoeducational social support intervention, named the Cancer-PEPSONE programme (CPP), on well parents' received and perceived social support, as well as on their psychological distress, quality of life (QOL) and parental capacity. The study was an open randomised controlled trial with a parallel-group design (N = 35; Intervention = 17, Controls = 18). The participants in the intervention group received CPP in their homes. Controls received support as usual. Data were collected in Norway using validated self-report questionnaires. Questionnaires were sent by post, before randomisation (T1), and at three- (T2) and six-month (T3) follow-up. Linear mixed models analyses revealed intervention effects on received (p = 0.04, d = 0.6) and perceived (p = 0.01, d = 1.0) social support, as well as on parental capacity (p = 0.02, d = 1.0), but not on psychological distress and QOL. Social support mediated the relationship between receiving CPP and later psychological distress. CPP may help well parents in maintaining social support and enhancing parental capacity. An improvement in social support may alleviate well parents' psychological distress.

Characteristics of the social networks of families living with parental cancer and support provided.

OBJECTIVE: To examine the characteristics of the social networks of families living with parental cancer and the kind of social support they provide compared with what the families report having received. BACKGROUND: Parental cancers are highly distressing for both parents and children. Among other concerns, families report a severe lack of social support. However, we know little about these families' private social networks, nor support provided and received as reported by network members and the family. METHODS: Using a descriptive cross-sectional design, 16 families living with parental cancer and 130 of their network members participated. Healthy parents and network members filled out The Assistance Questionnaire-Receivers of support (AQR)/The Assistance Questionnaire-Providers of Support (AQP). RESULTS: Network members were mainly resourceful friends (44%) and family members (42%). Only 1/3 became supporters at diagnosis, and nearly 50% had to be asked. Supporters provided a variety of types of help, especially emotional support. A match between the perception of the healthy parent and that of the network members was found for provided (p = 0.211) and received (p = 0.741) support. Supporters were satisfied with their provided support, experiencing it as rewarding and associated with few negative aspects. The STROBE checklist for observational studies was followed in reporting the results. CONCLUSIONS: The social networks, being mainly family and friends, were able to provide different types of help, especially emotional support. A useful suggestion may be to involve supporters at an earlier stage, providing more practical support. RELEVANCE FOR CLINICAL PRACTICE: Nurses are in a unique position to promote social support for families living with parental cancer by embracing a network focus, by emphasising the importance and potential of social support, by helping families to map their network and by teaching them how to be explicit in their requests for support.

Facing spousal cancer during child-rearing years: The short-term effects of the Cancer-PEPSONE programme-a single-center randomized controlled trial.

OBJECTIVE: To measure the short-term effects of the Cancer-PEPSONE programme (CPP) on the partners' received and perceived social support, psychological distress, and quality of life (QOL), as well as explore the role of received social support as a mediator of the intervention effects. METHODS: Open single-center randomized controlled trial, trial number 15982171(ISRCTN). Eligible participants were the partners of cancer patients who were concomitantly caring for minors (the well parents). The sample consisted of 35 participants randomly allocated to receive either intervention (n = 17) or support as usual (n = 18). At the 3-month follow-up (approximately 1 month after intervention), 24 continued to participate (intervention n = 13, control n = 11). The intervention group selected supporters to participate in CPP (N = 130). Data were obtained using validated questionnaire. RESULTS: The multivariate analysis of covariance revealed significant intervention effects (P = .03, η2p  = 0.42), with main effects on received and perceived social support. A mediational analysis suggested that CPP may have indirect effects on QOL through received social support. CONCLUSIONS: Even though the long-term effects are yet to be studied, CPP seems to increase social support for the well parents' short term, which in turn may improve their QOL. Given the study's low sample size, further replications in larger samples are required.

Health-related quality of life and post-traumatic stress disorder symptoms in accident and emergency attenders suffering from psychosocial crises: a longitudinal study.

AIMS: This paper is a report of a study of health-related quality of life and post-traumatic stress disorder symptoms in patients attending an Accident and Emergency department because of psychosocial crises. BACKGROUND: Psychosocial crises are commonplace globally, but there is little knowledge about patients attending Accident and Emergency departments because of psychosocial crises. METHODS: Data were collected at an Accident and Emergency department in Norway from September 2008 to June 2009. A total of 99 adults participated in the baseline study and 41 of these participated at 2 months follow-up. The Short Form-36 Health Survey and the Post Traumatic Symptom Scale were used to obtain data. FINDINGS: Participants reported significantly lower scores in all health-related quality of life domains at baseline compared with the general Norwegian population. The mental health score was two standard deviations below the norm. Health-related quality of life scores were improved and post-traumatic stress disorder symptoms were reduced after 2 months. High levels of post-traumatic stress disorder symptoms were reported by 78% of the participants at baseline and 59% at follow-up. Participants with high levels of post-traumatic stress disorder symptoms at follow-up also reported low health-related quality of life scores. CONCLUSION: This study suggests a need for an acute psychosocial intervention and an opportunity to receive follow-up support at Accident and Emergency departments.

Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature.

BACKGROUND: There has been a call for a framework to guide recovery-oriented practices in forensic mental health services. AIMS: This study aims to examine personal recovery and its challenges in forensic mental health settings in relation to the established framework for personal recovery in mental illness: connectedness, hope, identity, meaning and empowerment (CHIME). METHOD: This study is an updated and expanded systematic review and thematic synthesis of the qualitative literature. A systematic search of six electronic databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE and SocIndex) was carried out in January 2019, using the terms [Recover*] AND [Forensic OR Secure] AND [Patient* OR Offend* OR Service User*]. Only studies that included service user's own perceptions and were published from 2014 onward were included in the review. Data were examined with thematic synthesis and subsequently analysed in relation to the CHIME framework. RESULTS: Twenty-one studies were included in the review. Findings suggest that some adjustments to the original CHIME framework are needed for it to be more relevant to forensic populations, and that an additional recovery process regarding feeling safe and being secure (safety and security) could be added to CHIME, providing the CHIME-Secure framework (CHIME-S). Specific challenges and barriers for forensic recovery were identified and found to represent the opposite of the recovery processes defined by CHIME (e.g. hopelessness). CONCLUSIONS: We present the CHIME-S as a framework for the personal recovery processes of forensic mental health service users. The CHIME-S may guide the recovery-oriented work of forensic mental health services.

The Effects on Children's Anxiety and Quality of Life of a Psychoeducational Program for Families Living With Parental Cancer and Their Network: A Randomized Controlled Trial Study.

BACKGROUND: Families living with parental cancer report lack of social support. The Cancer PEPSONE Program (CPP) was developed to bridge the gap between the families and their network. OBJECTIVE: The aims of this study were to study the effect of the CPP on children's anxiety and quality of life (QOL) and examine the association between the CPP's effect on their well parents' received social support, QOL, and psychological distress and the children's anxiety and QOL. METHODS: The CPP, a psychoeducational program for the families and their social network, was evaluated using a randomized controlled trial design. The children and their well parents completed questionnaires measuring QOL, psychological distress, and social support at baseline and after 3 and 6 months. RESULTS: Thirty-five families were enrolled (18 intervention, 17 controls). The CPP stabilized the children's family function, although the family function largely (d = 0.86) decreased in the control group (P = .018). No significant effects were found on anxiety, overall QOL, or QOL subdimensions. Significant correlations were documented between the children's levels of anxiety and the well parents' received social support (r = -0.196, P < .001), QOL (r = -0.138, P < .05), and psychological distress (r = 0.166, P < .05). CONCLUSIONS: The CPP seems to stabilize the children's perceived family function but did not target the other outcomes. Further studies with larger samples are needed. IMPLICATIONS FOR CLINICAL PRACTICE: Optimizing social network for families living with parental cancer may support the family's function. Actions should be initiated to increase the well parents' social support, QOL, and psychological distress, which may also benefit the children.

Anxiety and the Quality of Life of Children Living With Parental Cancer.

BACKGROUND: Previous research on children living with parental cancer has mainly focused on the psychosocial challenges, but few studies have explored their health-related quality of life (HRQOL). This is important to promote well-being and discover areas of distress, as well as positive aspects of the children's life. OBJECTIVE: The aim of this study was to study how children's HRQOL is influenced by anxiety and whether age and gender act as moderators for this relationship. METHODS: This study used a survey with a cross-sectional design, including 35 children between 8 and 18 years old (mean, 13.3 years old) living with parental cancer. Questionnaires of HRQOL (Kinder Lebensqualität) and anxiety (Revised Child Manifest Anxiety Scale) were used. RESULTS: The children reported higher anxiety and lower HRQOL than the controls. The children's physiological (P = .03), emotional (P = .04), and school (P = .00) functions were significantly impaired, whereas they scored in line with the controls on self-esteem, family, friends, and overall HRQOL. A negative correlation (r = -0.707, P < .01) between anxiety and HRQOL was found. Neither age nor gender acted as a moderator between anxiety and HRQOL. CONCLUSIONS: A one-dimensional focus on anxiety may not capture these children's multidimensional challenges. In contrast, a focus on HRQOL may give important knowledge of the children's challenges, as well as areas where they function well. IMPLICATIONS FOR PRACTICE: Healthcare professionals need to work collaboratively across disciplines and have a multidimensional focus in caring for patients with cancer who have children. They must provide both the parents and children with adequate information and tools to handle their family health situation to promote the children's HRQOL.

Facing Spousal Cancer During Child-Rearing Years: Do Social Support and Hardiness Moderate the Impact of Psychological Distress on Quality of Life?

BACKGROUND: Partners of cancer patients report psychological distress and reduced quality of life. However, partners' mental health status and quality of life during child-rearing years and the influence of social support and hardiness on their well-being have not yet been studied. OBJECTIVE: The aim of this study was to describe psychological distress, quality of life, social support, and hardiness of the partners facing spousal cancer during child-rearing years and investigate whether social support or hardiness moderated the relationship between psychological distress and quality of life. METHODS: Cross-sectional data were collected in Norway from December 2013 to July 2015 as part of the Cancer-PEPSONE study. RESULTS: Five questionnaires were administered to 14 females and 21 males (n = 35). Participants reported more psychological distress and lower quality-of-life scores than other healthy Norwegian populations. Psychological distress seemed to be associated with their not being in control of their futures. Received social support moderated the effect of psychological distress on quality of life. CONCLUSIONS: Facing spousal cancer during child-rearing years seemed to have a substantial impact on partners' mental health and an adverse impact on their quality of life. Accordingly, these partners' self-care abilities may be reduced. Received social support may reduce the multiple burdens and consequently allow for enhancement of self-care. IMPLICATIONS FOR PRACTICE: Interventions should aim to improve the social support provided to child-rearing partners, which may improve their quality of life. Providing adequate information about their partner's cancer illness and treatment may enhance their feelings of control, which may be beneficial for their mental health status.

Systematic Early Intervention for Bereaved: Study Protocol of a Pilot Randomized Controlled Trial With Families Who Suddenly Lose a Partner and a Parent.

BACKGROUND: Grief has been associated with several long-term negative outcomes for both surviving parents and bereaved children, especially when it is preceded by unnatural and violent deaths. Nevertheless, it has been an underestimated public health problem with few, if any, empirically documented early preventive intervention programs. The best time to start them is also a major question that requires further evidence. OBJECTIVE: The overall aim of this study is to assess the feasibility of a future larger trial, informing sample size calculation, recruitment/randomization procedures, retention rates, data collection forms, and outcomes. This study will also explore: (1) the early effects of Systematic Early Intervention for Bereaved (SEIB) compared with the early effects of care as usual, and (2) the effects of the immediate SEIB version compared with the effects of the delayed SEIB version. METHODS: In a pilot randomized controlled trial (RCT) with a delayed intervention design, suddenly bereaved families will be assigned to: the immediate-SEIB intervention group, or the delayed-SEIB intervention group. Participants will fill in a set of self-report measures at baseline, and after 3, 6, and 9 months follow-up. Quantitative data on traumatic stress symptoms, complicated grief, psychological wellbeing, daily functioning, social support, parental capacity, parenting practices, and family functioning will be collected to inform power calculations and explore SEIB's preliminary effects. Data on the flow of participants throughout the trial will be analyzed in order to estimate recruitment and retention rates. Two brief questionnaires were developed to assess recruitment procedures, randomization, and data collection materials. RESULTS: Recruitment for this project started in August 2015, and follow-up data collection will be completed in June 2017. CONCLUSIONS: This study prepares the ground work for the design and implementation of a main trial and may add preliminary knowledge to the significance of early supportive practices that have been commonly used regardless of their sparse evidence.

Optimizing Social Network Support to Families Living With Parental Cancer: Research Protocol for the Cancer-PEPSONE Study.

BACKGROUND: Parental cancer can have a significant impact on a family's psychosocial functioning and quality of life, whereby the children's situation is strongly related to parental coping and capacity. Such parents ask for more help in order to increase their care capacity, while the network is often insecure about how to help and thereby withdraw. They ask for guidance and training to be able to support cancer families. Based on this, the Cancer- Psycho-Educational Program for the SOcial NEtwork (PEPSONE) study was developed. OBJECTIVE: To optimize social network support through a psycho-educational program for families living with parental cancer and their network members in order to increase parental capacity and thereby secure the children's safety and quality of life. METHODS: A randomized controlled trial (RCT) in which families (N=60) living with parental cancer will be randomized to either an intervention group or a control group. The intervention will last for 3 hours and includes (1) introduction, (2) psycho-education (living with cancer in the family and the importance of social network support), and (3) discussion (this family's need for social support). Primary outcomes are social support, mental health, and quality of life, and secondary outcomes are resilience and parental capacity. Data will be collected by a set of questionnaires distributed to healthy parents (N=60) living with a partner with cancer, one child in the family between 8-18 years of age (N=60), and network members (N=210) of the intervention families at inclusion, and after 3 and 6 months. Comparing differences between the intervention group (n=30) and the control group (n=30), the power analysis shows that P<.05 and a statistical power = .80 would detect effect sizes of clinical interest. RESULTS: This paper presents the Cancer-PEPSON study's protocol to provide a broader understanding of the background and content of the program. The study is ongoing until August 2016 and the first results are anticipated to be finished by November 2015. CONCLUSIONS: To our knowledge, this will be the first RCT study to optimize social network support through a psycho-educational program for families living with parental cancer and their network members, as well as provide an evidence basis for social network support. The results may provide important knowledge that is useful for clinical practice and further research. The trial is reported according to the CONSORT checklist. CLINICALTRIAL: International Standard Randomized Controlled Trial Number (ISRCTN): 15982171; http://www.controlled-trials.com/ISRCTN15982171/15982171 (Archived by WebCite at http://www.webcitation.org/6cg9zunS0).