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.

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.

[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.

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 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.

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 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.

[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 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.

A model of facilitative communication for support of general hospital nurses nursing mentally ill people. Part 2: model description and evaluation.

Part 1 of this article dealt with a full description of the research design and methods. This article aims at describing a model of facilitative communication to support general hospital nurses nursing the mentally-ill. In this article a model of facilitative communication applicable to any general hospital setting is proposed. Fundamental assumptions and relationship statements are highlighted and the structure and process of facilitative communication is described according to the three steps employed: 1) assisting the general hospital nurse learn the skill; 2) assisting the general hospital nurse practise the skill in order to develop confidence; and 3) using the skill in a work setting. The guidelines for operationalizing this model are dealt with in the next article. The evaluation of the model is also briefly described.

A model of facilitative communication for the support of general hospital nurses nursing mentally ill people. Part I: background, problem statement and research methodology.

The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa creates stress among nurses employed in these settings who are not psychiatric trained. This manifests itself in negative attitudes displayed towards mentally ill people. The aim of this paper is to discuss the process followed in the development of the model of facilitative communication. A theory generative design was used. The research methods were dealt with in four steps of theory generation as set out below. Step 1 entailed concept analysis. This step was dealt with in two phases, namely concept identification and concept definition. During concept identification, a qualitative research strategy that is explorative, descriptive and contextual was used. This was achieved through field research conducted in an urban general hospital. A sample of twelve professional nurses was selected from a population of 800 professional nurses employed in a general hospital using the purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. Giorgi's method of descriptive data analysis (1985) was used. Four themes emerged from the results of the study. The main concepts of the model were identified and classified using a survey list of Dickoff et al. (1968). Step 2 dealt with the creation of interrelationship statements between concepts identified in Step 1, while Step 3 dealt with the description of the model using strategies proposed by Chinn and Kramer (1991). In Step 4, the description of guidelines for operationalizing in practice was ensured. To ensure valid results, a model for trustworthiness proposed by Guba (Lincoln & Guba, 1985) was used. The following criteria for trustworthiness were applied in all the steps of theory generation: truth value, applicability, consistency and neutrality.

Community-based curriculum in psychiatric nursing science.

As community-based health care delivery is now a prominent feature of the health care system in South Africa, nursing curricula are being challenged to prepare student nurses for community-based nursing roles and responsibilities. The purpose of this study was to describe guidelines for a community-based curriculum in psychiatric nursing science for a nursing college in KwaZulu-Natal. A qualitative, quantitative, exploratory, descriptive and contextual design was employed. To reach the purpose of the study, a situational analysis was done in three phases to identify the principles for a community-based curriculum for psychiatric nursing science. PHASE I: A document analysis of relevant government policies and legislation. PHASE II: Statistics from psychiatric hospitals and community psychiatric clinics. PHASE III: Focus group interviews with nurse educators and literature control and conceptual framework. The principles obtained from the three phases were used to formulate the guidelines for a community-based curriculum in psychiatric nursing science. (PHASE IV): Eight guidelines with practical implications are described for the implementation of a Community-based curriculum in Psychiatric Nursing Science.

[Effective communication with the mentally challenged person during treatment of minor ailments]. / Fasiliterende kommunikasie met die verstandelik vertraagde persoon tydens die behandeling van geringe ongesteldhede.

The research objectives were to explore and describe the nature of communication with the mentally retarded adult during treatment of minor ailments; and to describe guidelines for the community nurse in order to facilitate more effective communication during the treatment of minor ailments in the mentally retarded adult for the promotion, maintenance and restoration of the mentally retarded individual's health. The community nurse pays attention to the protection of the mentally retarded individual's health, and identifies and treats minor ailments encountered by the mentally retarded individual. Because of the disability of the adults, lacking communication and obstacles in the exchange and interpretation of communication, could take place between the community nurse and the mentally retarded adult. The responsibility lies with the community nurse to facilitate effective communication, since the mentally retarded individual is not always capable of speaking on his/her own behalf. Guidelines are needed for the facilitation of effective communication between the community nurse and the mentally retarded adult during the treatment of minor ailments. In this research, use were made of a qulitative, exploratory, descriptive and contextual design. The research method consisted of participative observation during which video recording and the taking of field notes were applied. Two themes were identified during data analysis, namely: Verbal communication is aimed at the treatment of wounds. The more functional and task-orientated the community nurse's interaction with the mentally retarded individual, the more the mentally retarded individual would generate symptoms to establish emotional contact and interaction; The non-verbal behaviour of the community nurse focuses on the treatment of wounds and organisation of the environment. The more structure is created, the more play-out-behaviour is shown by the mentally retarded individual in need of contact. The researcher came to the conclusion that the community nurse refrains form near/close contact with the mentally retarded individual, to bridge her own discomfort. The community nurse is "busy" with the act of treating wounds, in order to refrain from effective interaction.