Nurse managed patient focused assessment and care: A grounded theory of qualified nurses in acute and critical care settings assessing the mental capacity of adult patients.

AIMS: To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients. BACKGROUND: Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision-making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care. DESIGN: A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway. METHODS: Data were collected through digitally recorded, semi-structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist. RESULTS: Informal, intuitive, holistic nurse-led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care. CONCLUSION: This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness. RELEVANCE TO CLINICAL PRACTICE: This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse.

Mental toughness attributes in Judo: perceptions of athletes / Atributos de fuerza mental en el Judo: percepciones de los atletas / Características de força psicológica no Judo: percepções de atletas

Perceptions of mental toughness attributes were explored among Judo competitors. Twelve Portuguese judokas from different levels of achievement underwent a semi-structured interview, based on Personal Construct Psychology "sociality" and "dichotomy" corollaries (Kelly, 1991). Properties and dimensions of each conceptual category arose from the data among the verbatim transcribed interviews. Inductive content analysis revealed 22 attributes that composed mental toughness in competitive Judo. Emotional regulation, resilience, self-confidence, attention regulation, self-motivation and optimism were reported by all subjects of the sample. In relation to previous single-sport researches that explored mental toughness attributes, our results supported the existence of large conceptual similarities across sports, despite subtle differences in Judo discussed in reference to optimism, self-improvement, pragmatism and self-presentation regulation. Self-esteem and adaptability emerged as a novelty in the sport’s mental toughness literature. Combativity was suggested to be the only mental toughness attribute rather peculiar to Judo

El objetivo del presente estudio fue explorar las percepciones de los atributos de fuerza mental entre los competidores de Judo. Doce judocas Portugueses de diferentes niveles de realización deportiva fueron sometidos a una entrevista semiestructurada, basada en corolarios de sociabilidad y dicotomía de la teoría Personal Construct Psychology (Kelly, 1991). De las entrevistas realizadas resultaron 148 páginas de datos transcritos verbatim. A partir del análisis de contenido de manera inductiva surgieron las propiedades y dimensiones de cada categoría conceptual, totalizando 22 atributos que compusieron la fuerza mental en el Judo de competición. La regulación emocional, la resiliencia, la autoconfianza, la regulación de la atención, la automotivación y el optimismo fueron mencionados por todos los sujetos de la muestra. En relación con las investigaciones anteriores de un solo deporte que exploraron los atributos de la fuerza mental, nuestros resultados apoyaron la existencia de grandes similitudes conceptuales en los deportes, a pesar de las diferencias sutiles en Judo discutidas en referencia al optimismo, el auto-perfeccionamiento, el pragmatismo y la regulación de la autopresentación. La autoestima y la adaptabilidad surgieron como un nuevo aporte a la literatura de fuerza mental en el deporte. Se sugirió que la combatividad fue el único atributo de fuerza mental bastante peculiar al Judo

Percepções dos atributos de força psicológica foram exploradas em competidores de Judo. Doze judocas Portugueses, com diferentes níveis de realização competitiva, foram individualmente submetidos a uma entrevista semi-estruturada, assente nos corolários de sociabilidade e dicotomia da teoria Personal Construct Psychology proposta por Kelly (1991). Das entrevistas realizadas resultaram 148 páginas de dados transcritos verbatim. Da análise indutiva de conteúdo emergiram as propriedades e dimensões de cada categoria conceptual, totalizando 22 atributos que compuseram a força psicológica no Judo de competição. A regulação emocional, a resiliência, a autoconfiança, a regulação da atenção, a auto-motivação e o optimismo foram reportados por todos os sujeitos da amostra. Por comparação a estudos anteriores que exploraram os atributos de força psicológica num só desporto, os nossos resultados apoiaram a existência de grandes semelhanças conceptuais entre desportos, pese embora a obtenção de diferenças subtis no Judo discutidas em referência ao optimismo, ao auto-aperfeiçoamento, ao pragmatismo e à regulação da auto-apresentação. A auto-estima e a adaptabilidade emergiram enquanto novidade na literatura de força psicológica no desporto. A combatividade foi sugerida como sendo o único atributo de força psicológica bastante peculiar ao Judo

The African Indigenous Lens of Understanding Spirituality: Reflection on Key Emerging Concepts from a Reviewed Literature.

In this paper, we will present a reflection on reviewed literature on African indigenous understanding of spirituality, highlighting the influence of this concept on notions of the self, motivation and well-being. The indigenous understanding of spirituality is central to the understanding of the self as distinct, but positioned within the relational-collective self. This African indigenous perception of the self is grounded within the autonomous experience of the tenets of spirituality, which is explored in this paper through the lens of self-determination theory. The experience of autonomy, which is represented in this paper as choice and consent, competence and relatedness within spirituality, is considered as an intrinsic motivation factor for African indigenous communities to achieve well-being. Hence, we argue for the relevance of identifying and exploring ways that an understanding of the African indigenous spiritual belief systems, and the various ways that this understanding impacts on well-being for African indigenous communities, can be unearthed and scrutinized.

Providing support to surrogate decision-makers for people living with dementia: Healthcare professional, organisational and community responsibilities.

The prevalence of dementia will continue to increase with the ageing of the population. Many people living with dementia will reach a stage where surrogate decision-makers-mostly family carers-will need to make a range of decisions on their behalf. The aim of this study was to learn from surrogate decision-makers how they can be most effectively supported in this role. The study employed a qualitative design using semi-structured face-to-face or telephone interviews with a purposive sample of 34 surrogate decision-makers of people living with dementia. Transcripts of participant interviews were reviewed using a thematic approach to analysis. Four main themes were identified from this analysis: needing greater community awareness of dementia and its impact; intervening early in cognitive decline; relying on health professionals for ongoing support; and seeking and using support from wherever is relevant for each person. Based on this analysis and a review of the literature, we propose a wholistic set of recommendations for the support of surrogate decision-makers. Healthcare professionals need to help family carers understand the likely trajectory of dementia, including the significance of surrogate decision-making. They can support the person living with dementia and their surrogates to undertake advance care planning and they can act as empathic guides during this process. Health and community care organisations need to provide a "key worker" model wherever possible so that the person living with dementia and their surrogate decision-maker do not have to seek support from multiple staff members or organisations. Carer support programmes can routinely include information and resources about surrogate decision-making. Community and government organisations can help people prepare for the possibility of becoming surrogate decision-makers by promoting a greater public awareness and understanding of both dementia and advance care planning.

[Psychiatric treatment--legal aspects]. / Rechtliche Aspekte einer Behandlung in der Psychiatrie.

Doctors want to save lives and promote health. But their patients have the right to decide for themselves about what doctors do with them, and they are free to refuse treatment, even if it is unreasonable from a medical perspective. The law acknowledges this freedom even if a patient is incapable of responsible self-determination as a result of (mental) illness. Treatment contrary to the patient's declared intention will be allowed only under specific, narrow circumstances. These requirements must be legally established in a clear and precise manner.

The MBT Adherence and Competence Scale (MBT-ACS): development, structure and reliability.

The properties of the 17-item Mentalization-Based Treatment Adherence and Competence Scale (MBT-ACS) were investigated in a reliability study in which 18 psychotherapy sessions, comprising two sessions by nine different therapists, were rated by seven different raters. The overall reliabilities for adherence and competence for seven raters were high, .84 and .88 respectively. The level of reliability declined by number of raters but was still acceptable for two raters (.60 and .68). The reliabilities for the various items differed. The MBT-ACS was found to be an appropriate rating measure for treatment fidelity and useful for the purposes of quality control and supervision. The reliability may be enhanced by redefining some items and reducing their numbers.

Assessment of decision-making capacity: views and experiences of consultation psychiatrists.

BACKGROUND: Decision-making capacity (DMC) assessments can have profound consequences for patients. With an aging population, an increasing emphasis on shared decision-making, and a rising number of potential medical interventions, the need for such assessments will continue to grow. OBJECTIVE: To assess psychosomatic medicine clinicians' training, experiences, and views about DMC assessments. METHOD: Online survey of members of the Academy of Psychosomatic Medicine (APM). Of 780 eligible members, 288 responded to the survey (36.9% response rate). RESULTS: Approximately 1 in 6 psychiatric consultations are DMC assessments. Ninety percent of respondents reported that at least half of their capacity assessments involve patients older than 60 years. DMC assessments were seen as more challenging and time-consuming than other types of consultations; yet training in capacity evaluations was seen as suboptimal and half of respondents felt the evidence-base guiding DMC assessment is somewhat or much weaker than for other types of psychiatric consultations. In addition, the practice of capacity assessment seems to vary widely with no consistent approach among respondents. Respondents strongly endorsed multiple areas and topics for potential future research, indicating a desire for a stronger evidence-base. CONCLUSIONS: Members of the APM perceive capacity assessments as common and challenging. Yet they perceive having received subpar training with relatively weak evidence to guide their current practice. Future research should address these potential deficiencies, given the likelihood that DMC assessments will only become more common.

Reflective journals of students taking a positive youth-development course in a university context in Hong Kong.

To promote the holistic development of university students, a course entitled "Tomorrow's Leaders" was developed and offered at The Hong Kong Polytechnic University. Based on a case study approach, reflective journals of five outstanding students of the course are presented and analyzed (i.e., thick description), with several themes emerging from the reflection. First, the students liked the course, and they identified many positive attributes. Second, the students appreciated the instructors. Third, the students viewed that the course contributed to different aspects of their development. Fourth, some areas of improvements were proposed. In conjunction with other evaluation mechanisms, the present findings strongly suggest that the course is able to promote psychosocial competencies in university students taking this course.

Psychometric properties of the Spanish validation of the Five Facets of Mindfulness Questionnaire (FFMQ)

Background and Objectives: Mindfulness-based therapies have demonstrated effectiveness in many clinical contexts. Various therapies that train mindfulness skills have proliferated in recent years. There is increasing interest in mindfulness-based therapies and in incorporating instruments that measure mindfulness in order to understand its role in clinical and basic research. The Five Facets of Mindfulness Questionnaire (FFMQ) is a questionnaire for measuring mindfulness; it was derived from a factor analysis of five different questionnaires that measure a trait-like general tendency to be mindful in daily life. The objective of this study is to validate the FFMQ in a Spanish sample. Methods: The FFMQ was administered to a sample of 462 subjects ranging from 18 to63 years (X = 27.9; SD = 9.75). The sample was composed by clinical (n = 146) and nonclinical (n = 226) subsamples. Results: The internal reliability of the scales ranged from acceptable to very good. Convergent analysis was conducted by computing Pearson’s correlations, showing high correlations. The factorial structure is the same as that proposed by Baer et al. Conclusions: The FFMQ proved to be an effective instrument for measuring mindfulness in clinical and non-clinical Spanish samples (AU)

What affects pleasure in persons with advanced stage dementia?

We examined the impact of environmental, person, and stimulus characteristics on pleasure in persons with dementia. Study participants were 193 residents of 7 Maryland nursing homes who were presented with 25 stimuli from these categories: live human social stimuli, live pet social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Systematic observations of pleasure in the natural environment were conducted using Lawton's Modified Behavior Stream. Analysis showed that pleasure is related to stimulus category, personal attributes and environmental conditions. In the multivariate analyses, all types of social stimuli (live and simulated, human and nonhuman), self-identity stimuli, and music were related to significantly higher levels of pleasure than the control condition. Females and persons with higher ADL and communication functional status exhibited more pleasure. Pleasure was most likely to occur in environments with moderate noise levels. These results demonstrate that these nursing home residents are indeed capable of showing pleasure. Caregivers of nursing home residents with dementia should incorporate social, self-identity, and music stimuli into their residents' care plans so that eliciting pleasure from each resident becomes the norm rather than a random occurrence.

Teaching money literacy in a positive youth development program: the project P.A.T.H.S. in Hong Kong.

In view of the high impact of materialistic orientation among children and adolescents, financial educational programs are provided as preventive measures. Without a clear framework, it is impossible to evaluate these programs. The goals of this paper are threefold. Firstly, the phenomena related to adolescent materialistic orientation and its associated problems in Hong Kong are examined. Secondly, the concept of financial education as a preventive measure is reviewed. Both board and narrow definitions of money literacy are examined. A framework on money literacy for children and adolescents as a founding stone for financial education is proposed. The framework finds its support from a typology proposed by the authors and results from an integration of research findings on dimensions of the concepts of money and success. Finally, curriculum units for Grades 7 to 9 students in a positive youth development program (the Project P.A.T.H.S.) are developed using the framework.

In quest of constitutional principles of "neurolaw".

The growing use of brain imaging technology and the developing of cognitive neuroscience pose unaccustomed challenges to legal systems. Until now, the fields of Law much affected are the civil and criminal law and procedure, but the constitutional dimension of "neurolaw" cannot be easily underestimated. As the capacity to investigate and to trace brain mechanisms and functional neural activities increases, it becomes urgent the recognition and definition of the unalienable rights and fundamental values in respect of this new techno-scientific power, that must be protected and safeguard at "constitutional level" of norms such as: human dignity, personal identity, authenticity and the pursuit of individual "happiness". As the same as for the law regulating research and experimentation on human genome adopted in the past years, one may also argue if the above mentioned fundamental principles of "neurolaw" must be fixed and disciplined also at European and International level.

Speech and school performance in children with benign partial epilepsy with centro-temporal spikes (BCECTS).

PURPOSE: To assess prospectively language and speech ability in children with benign partial epilepsy with centro-temporal spikes (BCECTS). To evaluate academic performance and social competencies both during the active disease and after remission. METHODS: Right-handed school children with typical BCECTS and a control group matched by age, sex, handedness and socioeconomic status were examined. The German version of WISC-R, the "Tübinger Luria Christensen Neuropsychological Test Set for children" (TUKI), the "Verbal Learning Memory Test" (VLMT), the "Heidelberger Speech Development Test-second edition" (HSET), and the "Salzburger reading and writing test" (SLRT) were applied. The Child Behavior Checklist (CBCL) and a semi-structured interview were performed with the children's teachers to gain insight into school performance, behavioral and emotional problems. RESULTS: During the active phase, the patient group - despite normal global intellectual abilities - showed few, but significant impairments both in expressive speech and in receptive and expressive vocabulary. A significant deficit in the ability to recognize and express interpersonal relations was also found. Patients' teachers stated deficits concerning academic performance and complained about disturbing behavior. Parents reported significantly more psycho-pathological features in the subscales "Aggressive Behavior", "Attention Problems" and "Anxious/Depressed" of the CBCL. Results were independent of medication and spike localization. After complete recovery from BCECTS, these problems were not found any more. CONCLUSIONS: Both deficits of speech-related abilities (in both expressive and receptive vocabulary) and behavioral disturbances can be detected in children with typical BCECTS, but are no longer apparent after remission of the seizure disorder.

DNR versus DNT: clinical implications of a conceptual ambiguity: a case analysis.

Psychiatrists who practice psychosomatic medicine are routinely called upon to help resolve ethical dilemmas that arise in the care of patients near the end of their lives. Psychosomatic-medicine psychiatrists may be of unique value in these situations because of the clinical insights that we bring to the care of the dying patient. In particular, our subspecialty brings expertise related to the evaluation of decisional capacity of patients who are faced with accepting or declining end-of-life clinical interventions, such as resuscitation and intubation. In this first entry in a new bioethics case series in Psychosomatics, we will lay the groundwork for examining a complex patient case and provide an illustrative analysis of the end-of-life care issues that may be addressed by psychiatrists who practice psychosomatic medicine.

[Mental competence in the context of deep brain stimulation]. / Wilsbekwaamheid in de context van elektrostimulatie van de hersenen.

In a case of Parkinson's disease, the patient was treated with deep brain stimulation of the subthalamic nucleus (STN-DBS). STN-DBS affected the mental competence of the patient and ethical questions were raised about the decision as to the direction of further treatment. The patient was asked for his opinion on the therapeutic options during a phase of non-stimulation and chose to be stimulated and admitted to a psychiatric hospital because of mental incompetence rather than remaining unstimulated, mentally competent but bedridden. Developments in the neurosciences (including STN-DBS) raise a number of different fundamental (theoretical and philosophical) as well as practical questions. STN-DBS can have various unintended (behavioural) effects. In the case presented, more weight was rightly given to the mental competence of the unstimulated patient, although comments can be made with regard to his decision making, as his choice was made in a phase of serious distress. Attention is paid to the relevance of a so-called self-binding directive. STN-DBS is not morally neutral and the case involves a tragic dilemma: a conflict between irreconcilable duties for the physician. The further development and proliferation of STN-DBS requires caution and moral deliberation. It remains important to search for alternative treatment strategies with less undesirable side effects.

[Manipulation of mental competence: an ethical problem in case of electrical stimulation of the subthalamic nucleus for severe Parkinson's disease]. / Manipuleerbare wilsbekwaamheid: een ethisch probleem bij elektrostimulatie van de nucleus subthalamicus voor ernstige ziekte van Parkinson.

Three years after the implantation of electrodes in the subthalamic nucleus (STN) and the start of deep brain stimulation (DBS) for advanced Parkinson's disease, a 62-year-old man was admitted because of a stimulation-related manic state that did not respond to treatment with a mood stabiliser and that led to chaotic behaviour, megalomania, serious financial debts and mental incompetence. Although adjustment of the stimulation parameters resulted in a normophoric state with a return of insight and capacity to judge, this was only at the cost of a serious exacerbation of his motor symptoms that left the patient bedridden. There was no therapeutic margin between the two states. Ultimately, there seemed to be only two alternatives: to admit the patient to a nursing home because of serious invalidity, but mentally in good condition, or to admit the patient to a chronic psychiatric ward because of a manic state, but with acceptable motor capacity and ADL functions. Thorough ethical evaluation followed. When not being stimulated, the patient was considered competent to decide about his own treatment; in this condition the patient chose for the second option. In accordance with his own wishes he was therefore legally committed to a chronic ward in the regional psychiatric hospital. The current ethical views on mental competence do not consider the potential influence of modern methods of treatment such as STN-DBS on this capacity.

Quality of life of clients with schizophrenia.

BACKGROUND: Because of the deinstitutionalization of mental health care in Hong Kong that has taken place since the 1980s, many people with mental health problems are being cared for in the community. The majority of clients have a diagnosis of schizophrenia, and many have a long duration of illness and multiple readmissions. There is concern about their quality of life. AIM: To investigate quality of life and related factors in clients with a diagnosis of schizophrenia in Hong Kong. DESIGN: A convenience sample was recruited from a psychiatric outpatient department. Structured face-to-face interviews were conducted using the Brief Psychiatric Rating Scale and the Hong Kong Chinese World Health Organization Quality of Life Scale-Brief Version. RESULTS: A total of 172 people participated in the study. Most of them were single and unemployed. They were least satisfied with their psychological health, financial situation, life enjoyment and sexual activity. Women (n = 91) reported less satisfaction with quality of life than men (n = 86). Unemployed people (n = 100) were less satisfied with their quality of life than the employed (n = 76). Higher levels of mental health problems and higher numbers of previous hospitalizations were associated with negative perceptions of quality of life. DISCUSSION: People with mental health problems had significantly less satisfaction with their quality of life than a sample from the general population in Hong Kong surveyed in a previous study. As well as experiencing distressing mental symptoms, they had many difficulties, such as financial problems, unemployment and lack of opportunities to participate in social activities, that resulted from stigma and discrimination. These had a great impact on their quality of life. STUDY LIMITATIONS: Because of the small sample size and its convenience nature, the findings may not be generalizable to all clients in Hong Kong. A generic instrument was used to measure quality of life, and this may not have been sensitive to certain aspects of mental health clients' lives. CONCLUSION: The findings suggest that there is a need to strengthen social and vocational rehabilitation for people with mental health problems in Hong Kong. A more holistic and intensive model of care is required to meet their complex needs. A larger and more diverse sample should be used in future research, and a quality of life measure specifically designed for people with mental health problems should be used.

Doing play: competency, control, and expression.

This qualitative study investigated the personal experiences of children with cerebral palsy engaging in a virtual reality play intervention program. The study involved in-depth, focused interviews that were conducted with 19 participants aged 8-13 who had a diagnosis of cerebral palsy. A constant comparative inductive method of analysis was used, and several themes emerged. Findings were interpreted using the theory of flow, the theory of self-efficacy, and the model of playfulness in virtual reality computer interactions. The three themes uncovered in the data include (a) doing play, (b) it's my way that matters, and (c) how I see me. The sub-theme safety also emerged. Findings from this study showed that children with physical disabilities are often limited in their play experience compared to their peers without physical disabilities. Children perceived engagement in a virtual reality play intervention program as an enjoyable experience which increased their self-competence and self-efficacy. Participants experienced a sense of control and mastery over the virtual environment and were provided a safe way to explore and challenge their abilities. Participants perceived experiencing flow and reported perceived physical changes and increased social acceptance from both peers and family. These findings provide evidence that virtual reality continues to show promise as a pediatric rehabilitation play intervention tool.