Shared decision making in a semi-secluded chronic psychiatric ward: The reflective lifeworld experiences of patients with schizophrenia or schizoaffective disorders and nursing staff.

BACKGROUND: Shared decision making (SDM) enhances recovery-oriented mental healthcare, but literature predominately focuses on doctor-patient collaboration leaving the role of mental health nurses (MHN's) underexposed. AIM: This study describes the experiences of patients with schizophrenia or schizoaffective disorder with SDM in a semi-secluded psychiatric facility, and the attitudes toward SDM by MHN's. METHOD: A hermeneutic phenomenological design. RESULTS: Seven patients and six MHN's were interviewed. Although MHNs were skeptical to utilize SDM, and patients often feel omitted, investing in inter-human contact increased the therapeutic alliance. CONCLUSION: Tailored plan making and attainable goal setting, building trust, and providing hope are important incentives to enhance SDM.

Attitudes of patients with bipolar disorder toward the Life Chart Methodology: a phenomenological study.

BACKGROUND: The Dutch guideline for bipolar disorder (BD) recommends the use of the Life Chart Methodology (LCM) to help patients to monitor fluctuating mood patterns. But in practice patients show ambivalent attitudes toward this instrument. OBJECTIVE: To describe attitudes and motivations of patients with BD for (non-)using the LCM. DESIGN: A phenomenological study with unstructured in-depth interviews of 14 patients with BD. Patient narratives were audio-taped, transcribed verbatim, analyzed, and coded inductively. RESULTS: The results show that despite variability in perceptions and willingness to work with the LCM, the general attitude toward this instrument was a recognized value for using the LCM. However, the emotional impact of daily mood charting was experienced as a substantial burden, particularly during the early stages of diagnosis. CONCLUSION: The impact of the diagnosis of BD needs to be taken in account when introducing the instrument for the first time to a patient.

The user experiences and clinical outcomes of an online personal health record to support self-management of bipolar disorder: A pretest-posttest pilot study.

BACKGROUND: Self-management comprises knowledge, behavior, activities and resources providing people with bipolar disorder (BD) control over fluctuating mood and activity-patterns. The 'Self-management and Dialogue in Bipolar Disorder' project entailed the tailoring of an online personal health record (PHR) originally designed for the chronically ill to monitor condition and share information with their clinician to people with BD (PHR-BD). The aim of this study was to evaluate the feasibility, utility and user-experiences of participants with BD, relatives, and healthcare professionals who worked with the PHR-BD. METHODS: Post-test online closed- and open ended questionnaires were used to collect information on utility, and user-experiences with PHR-BD. A pre-posttest design to evaluate clinical effects on quality of life, empowerment, symptom reduction, changes in mood and activity, and illness burden and severity at baseline and at 12-months follow-up. RESULTS: Sixty-six participants with BD logged in at baseline. At study endpoint thirty-nine participants with BD, eleven professionals and one family caregiver filled out the evaluations. No significant differences in the clinical outcomes from baseline were found. Qualitative evaluations showed a frequent utility of the mood chart modules, improved communication between clinician and participant with BD and, increased insight in influencing factors of mood fluctuations. LIMITATIONS: Small convenience sample, no controls. CONCLUSIONS: The option to alternate the interface from a prospective to a retrospective mood chart , and integration with the personal crisis plan was considered to be of added value in self-managing BD. The findings of this study will guide the future implementation of the PHR-BD.