Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study.

Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.

A theory to guide nursing students caring for patients with suicidal tendencies on psychiatric clinical practicum.

Research concerning this issue demonstrates that nursing students initially feared interacting with and caring for patients with suicidal tendencies. However, there is a lack of research, which examines the care that is provided to patients that are suicidal, by nursing students. The aim of this study was to develop a theory to guide nursing students when caring for patients with suicidal tendencies on their psychiatric clinical practicum. A qualitative approach using Grounded Theory was used. A total of 22 nursing students who had provided care for suicidal patients were interviewed. The core category that emerged from the data was the 'changing of mindsets towards caring for suicidal patients and promotion of suicidal care competencies'. Other key categories linked to and enfolded within this core category were: suicidal risk assessment; protecting patients' safety; and, developing therapeutic communication competencies to advance suicidal care. This study could help fill a theory-practice gap for both psychiatric nursing teachers and students. Nurse teachers could use this theory as a map to help guide students caring for patients with suicidal tendencies and develop nursing students' suicidal care competencies.

Pivotal moments and changes in the Bonny Method of Guided Imagery and Music for patients with depression.

AIMS: To explore pivotal moments and changes during the Bonny Method of Guided Imagery and Music from the perspective of patients with depression. BACKGROUND: Depression has been described as an extremely difficult experience for people and is characterised by emotional distress and suffering. As depression progresses, symptoms increase and gradually influence all aspects of the lives of those affected. Few studies have been undertaken into the essence of inner and pivotal experiences during Guided Imagery and Music in patients with depression. DESIGN: A qualitative research design and discovery-oriented approach were used as the method of both data gathering and textual analysis. METHODS: This study conducted semi-structured interviews with five patients with depression after each of eight sessions of the Bonny Method of Guided Imagery and Music. Each session took place in a music therapy laboratory. Forty transcripts were organised into categories and analysed according to the discovery-oriented approach of Mahrer and Boulet, considering the dimensions of the Bonny Method of Guided Imagery and Music. Results. Nine patients with depression were recruited from a medical centre in southern Taiwan from 2004-2005. Five successfully completed eight Bonny Method of Guided Imagery and Music sessions. There were 141 statements coded into 10 subthemes and three themes describing pivotal moments: pushing aside the barrier, gaining new insight, moving forward. Each category was supported by three-four themes. The analysis also yielded three meaningful moments: releasing mind-body rigidity, awareness and inspiration, acceptance and inner transformation. Patients described personal emotional, cognitive and behavioural transformation during the Bonny Method of Guided Imagery and Music experiences. CONCLUSIONS: The discovery-oriented approach fulfilled the aim of gaining a valuable understanding of the psychological growth experiences of patients with depression during the Bonny Method of Guided Imagery and Music. RELEVANCE TO CLINICAL PRACTICE: Patients with depression particularly need comfort and caring. It is important that nurses offer interventions as adjuvants to medication. This study supports the feasibility of incorporating the Bonny Method of Guided Imagery and Music into the nursing management of patients with depression. Future studies are suggested to examine the interactive process of music stimulus and the multidimensional nature of imagery.

Effect of an Interactive Computerized Psycho-education System on patients suffering from depression.

AIMS: The aim of this study was to examine the effect of an Interactive Computerized Psycho-Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho-Education System vs. traditional pamphlet education approach. BACKGROUND: Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments. DESIGN AND METHOD: A preliminary pre and post quasi-experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho-Education System intervention programme (Interactive Computerized Psycho-Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale. RESULTS: In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho-Education System was about 30-180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non-compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30-100, with an average score of 74.7. CONCLUSION: The Interactive Computerized Psycho-Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression. RELEVANCE TO CLINICAL PRACTICE: Compared with a traditional approach, the combination of the Interactive Computerized Psycho-Education System and a nursing-consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression.

Initial formation of nursing philosophies following fundamental clinical practice: the experience of male nursing students.

The purpose of this preliminary study was to explore male nursing students' development of nursing philosophies during their fundamental nursing primary clinical practice. Purposive sampling was conducted at a department of nursing in a university in southern Taiwan between September and October 2005. Researchers gave each of the ten subjects selected for this study a semi-structured, in-depth interview. The interviews were tape recorded and then transcribed word by word, before the content analysis method was used to analyze data. The analysis results can be classified into three major categories and various associated themes. The first category, professional ambition choice, incorporates the four themes of: (1) acceptance of family members' or friends' recommendations; (2) consideration of career development factors; (3) eagerness to care for others; and (4) limitations imposed by academic achievements. The second category, professional gender expectations, incorporates the following four themes: (1) gender role revolutions; (2) expectations that "something rare is valued highly" ; (3) courage in addressing public misgivings about untraditional professional roles; and (4) formulaic gender gap problems. The third category, development of nursing philosophy following a primary clinical internship, incorporates the following five themes: (1) doubt regarding personal ability to master the complex tasks necessary to become a competent nurse; (2) translation of one's field of vision from the visible to the invisible; (3) stimulation of learning upon recognition of inadequacies; (4) pride in being engaged in the "sacred" work of caring; and (5) increased confidence in continuing a nursing career. The results of this study may guide nursing educators in promoting an active approach toward training and professional education.

Exploring the listening experiences during guided imagery and music therapy of outpatients with depression.

The purpose of this preliminary study was to explore the listening experiences of outpatient depression sufferers who underwent guided imagery and music therapy (GIM). A purposive sampling method was performed at the psychiatric outpatient clinic of a medical center in southern Taiwan from April 2003 to June 2004. The five subjects in this study all underwent a total of eight sessions of individual GIM therapy. The researcher invited a therapist to implement the GIM therapy sessions. Researchers conducted a semi-structured, in-depth telephone interview with each subject within 24 to 48 hours after each therapy session. Eight interviews were accomplished and transcribed for each case, and then subject to content analysis. The results showed a total of 55 important listening episodes, which could be categorized into the following 5 themes: (1) leisurely wandering in very natural sceneries; (2) creation of surreal virtual surroundings; (3) recollection of past life experiences; (4) submersion in thematic music melodies; and (5) experiencing various physical relaxation events. The triggering effect represented a combination of multiple factors, including music, the individual, the therapist and environment. The theme of each patient's imagery episode was a result of the effect of the four factors, with music having the greatest impact. This study hopes to present the listening experiences of depression sufferers in GIM therapy; to make suggestions for future investigations into subsequent impacts and changes that GIM has on patients; and to, perhaps, serve as references for future clinical practice or studies.

Significant experiences of token therapy from the perspective of psychotic patients.

The purpose of this study was to explore the perceived the significant experiences of psychiatric patients related to token therapy. A qualitative in-depth interview was applied to collect individual opinions and perceptions. The 13 patients included in this study, all of whom had been diagnosed with mental disorders, received a six-month program of token therapy. Semi-structured interviews of approximately 40 minutes each were held with each participant and transcribed for further analysis in accordance with the principals of content analysis. The three significant domains of experience of participants receiving token therapy included: (1) acknowledgement of token therapy significance, (2) appreciation of each step in terms of personal achievement, and (3) reinforcement from personal changes and family support. Findings support the application of token therapy in psychiatric rehabilitation settings using the strategy of applying appropriate positive or negative logos to communicate reinforcement in an immediate manner that is further enhanced by the public tracking of accumulated patient scores on an evaluation board. In this manner, the therapeutic environment is imbued with a critical empowerment function. The effective application in the future of token therapy in mental health rehabilitation programs is recommended.

Exploring the self-learning experiences of patients with depression participating in a multimedia education program.

The purpose of the present study was to explore the self-learning experiences of depression patients on interactive multimedia education program. Qualitative in-depth interviews were employed. Fourteen patients with a first episode of major depression were recruited from a psychiatric outpatient department. Explanations of the purposes of the exercise and on-the-spot teaching were provided by the researcher before the study began. A tape-recorded, semi-structured interview format was employed after two weeks. Data analysis was performed in the framework of line-by-line content, contextual and thematic analysis. Eight subjects successfully completed the entire learning activities. Content analysis revealed 4 main aspects of successful self-learning experiences: the triggering of learning motivation, the enjoyment of self-paced learning, support for the effects of learning materials, and the gaining of self- awareness and changes. The factors influencing learning performance were related to: environmental impact, the degree of familiarity with traditional learning, possession or non-possession of the necessary computer operation skills, and good computer support. However, the findings provide a preliminary understanding of the application of interactive multimedia education programs in terms of self-learning outcomes and recognizing key elements of learning impediments among the study sample. A larger sample size with different clinical contexts is recommended to determine the effect and generalizability for future research. Furthermore, the creation of a computerized learning environment with different educational styles is crucial to patients' success in obtaining depression-related information and understanding effective adaptive skills.