Understandings of influenza and influenza vaccination among high-risk urban dwelling Thai adults: a qualitative study.

BACKGROUND: The 2004 outbreak of influenza A H5N1 and the WHO's recommendation for national pandemic plans has led the Thai Ministry of Public Health to develop an influenza vaccination programme for high-risk adults. To date there is no available information to guide this intervention, and how to maximize the uptake of the vaccine by the Thai population. To address this knowledge gap, this study explored factors influencing urban-dwelling Thai adults' decisions whether or not to have the vaccine. It explored their beliefs about influenza and influenza vaccination, and other influences on their decisions. METHODS: In-depth interviews were conducted among 20 high-risk individuals who were aged 65 and over or under 65 years with chronic diseases requiring influenza vaccination. Interviews were tape recorded and analysed following using grounded theory. RESULTS: Most participants had insufficient knowledge about influenza and influenza vaccination. Their decisions in relation to vaccination were based on a number of factors, including salience of risk, influence of others, perception of the need for preventive health care and the availability of influenza vaccine. CONCLUSION: These findings underscore the need to consider and understand factors underlying people's vaccination decisions to create an effective influenza vaccination programme.

Upper-mantle volatile chemistry at Oldoinyo Lengai volcano and the origin of carbonatites.

Carbonatite lavas are highly unusual in that they contain almost no SiO(2) and are >50 per cent carbonate minerals. Although carbonatite magmatism has occurred throughout Earth's history, Oldoinyo Lengai, in Tanzania, is the only currently active volcano producing these exotic rocks. Here we show that volcanic gases captured during an eruptive episode at Oldoinyo Lengai are indistinguishable from those emitted along mid-ocean ridges, despite the fact that Oldoinyo Lengai carbonatites occur in a setting far removed from oceanic spreading centres. In contrast to lithophile trace elements, which are highly fractionated by the immiscible phase separation that produces these carbonatites, volatiles (CO(2), He, N(2) and Ar) are little affected by this process. Our results demonstrate that a globally homogenous reservoir exists in the upper mantle and supplies volatiles to both mid-ocean ridges and continental rifts. This argues against an unusually C-rich mantle being responsible for the genesis of Na-rich carbonatite and its nephelinite source magma at Oldoinyo Lengai. Rather, these carbonatites are formed in the shallow crust by immiscibility from silicate magmas (nephelinite), and are stable under eruption conditions as a result of their high Na contents.

Analysing and presenting qualitative data.

This paper provides a pragmatic approach to analysing qualitative data, using actual data from a qualitative dental public health study for demonstration purposes. The paper also critically explores how computers can be used to facilitate this process, the debate about the verification (validation) of qualitative analyses and how to write up and present qualitative research studies.

Seeing the psychiatrist: an autoethnographic account.

Autoethnography is a fairly recent approach to ethnography and one in which the writer becomes the 'subject' of the study. It remains an approach under question until more has been done in the field. In this account, I describe attending an interview with a psychiatrist, as a patient. I map out the process I encountered and offer, alongside the map, various critical and reflective comments. I offer a summary of my 'findings' and close with a critical evaluation both of the method and of the paper. Findings included: a comfortable and comforting 'setting up' of the interview; a sense of moving into the 'patient role'; a clear indication of how the interview would proceed; and empathic manner on the part of the psychiatrist and a sound process of follow-through with my general practitioner. In the critique section, I try to answer the question as to whether or not authoethnography is self-indulgent and the degree to which it can or cannot help others in understanding mental health issues. I remain uncertain about both the method and its value. In the end, it is probably for the reader to answer these questions.

Views of mental illness and mental health care in Thailand: a report of an ethnographic study.

This paper reports some of the findings of an ethnographic study carried out in Thailand over a 2-year period. Interviews were conducted with three clinical nurses, three student nurses, 14 nurse educators, one psychiatrist, one Buddhist monk and two lay people (n = 24) about their views of mental health and mental health care in Thailand. Data (comprising field notes and interview transcripts) were analysed with the aid of Atlas.ti. Data were also collected through observation and conversation. This paper reports only the findings from the interviews. Findings emerged under the following headings: Causes of mental illness; Status of the mentally ill; Karma; Merit making; Kwan; Treatment and care; Reasons for becoming a mental health nurse. A range of causes, including the effects of ghosts and spirits, were identified under the first heading. The stigma of mental illness was noted under the second. Karma and merit making are Buddhist concepts and were discussed by many respondents as was the animist concept of kwan. Treatment and care seemed to include both 'modern' and 'traditional' approaches. These findings are discussed and some tentative 'rules' that appear to exist within the culture are mooted. The study is descriptive in nature and the findings cannot be generalized; however, it is hoped that they go some way to illuminate aspects of Thai culture as they relate to the mental health and mental health nursing fields.

Sisyphus happy: the experience of depression.

Depression has been well documented, in the academic sense. This paper offers one person's experience of periods of depression. It describes symptoms and personal ideas about this commonly experienced condition. It raises questions about the legitimacy of psychiatric and psychological theorizing, and draws from various existential positions to support the text. The author suggests that depression is not, particularly a 'learning experience' and, far less, a form of personal growth.

Factors influencing the effectiveness of clinical supervision.

Clinical supervision is widely accepted as an essential prerequisite for high quality nursing care. This paper reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales, UK. Two hundred and sixty (32%) CMHNs from an estimated total population of 817 completed the Manchester Clinical Supervision Scale (MCCS) and a demographic questionnaire. The MCCS is a 36-item questionnaire measuring the quality and effectiveness of the supervision received. Three-quarters of CMHNs reported having participated in six or more sessions of supervision in their current posts. Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis. Perceived quality of supervision was also higher for those nurses who had chosen their supervisors, and where sessions took place away from the workplace. These findings have important implications for the organization and delivery of mental health nursing services.

A systematic review of stress and stress management interventions for mental health nurses.

BACKGROUND: Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained. AIM: The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies. METHOD: A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided. RESULTS: The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies. CONCLUSIONS: The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.

Ordinary chat and therapeutic conversation: phatic communication and mental health nursing.

This paper offers a definition of 'phatic communication' and identifies examples of it. The paper also illustrates how a knowledge of such communication is useful for mental health nurses in conversation with their clients and colleagues. The importance of turn taking in conversations is also discussed in a cultural context. Various examples of phatic communication are offered.

Specialist practice for UK community mental health nurses: the 1998--99 survey of course leaders.

Surveys of the leaders of the UK's post-qualifying education courses for community mental health nurses have taken place, on an annual basis, for over 10 years. In this paper, findings from the survey undertaken in the 1998--99 academic year are reported. These findings include: that most course leaders do not personally engage in clinical practice; that interprofessional education takes place at a minority of course centres, and that course philosophies and aims are characterised by an emphasis on both outcomes (in terms of, for example, skills acquisition, knowledge development and the ability to engage in reflective practice), and process (adult learning).

Reviewing the review process: towards good practice in the peer review of manuscripts submitted to nursing journals.

Publishing in peer reviewed journals is an essential activity for nurses working in higher education. This paper offers some reflections on the processes involve in the reviewing of articles submitted for publication, and explores some ways in which this system may be improved. All journals operate some kind of review process. This can range from, at one end, the editor making decisions about the suitability for publication of a submitted paper to, at the other end, papers being blind-reviewed by two (or sometimes more) external referees. This paper notes that there appears to be little or no consistency amongst the various nursing journals with respect to reviewing processes. Suggestions put forward in this article for consideration include: the standardisation of peer review systems across journals; the construction of guidelines for referees which caution against ad hominem attacks on authors; and the introduction of 'open' reviewing.

A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community.

AIMS: The aim of the study was to examine the variety, frequency and severity of stressors experienced by community mental health nurses (CMHNs) in Wales. BACKGROUND: Numerous studies undertaken throughout the United Kingdom (UK) have indicated that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout. Sample sizes have tended to be small and participants have been drawn mainly from sites in England. METHODS: A questionnaire booklet, which included a number of validated measures, was distributed to 614 CMHNs. These included Maslach Human Services Survey, Community Psychiatric Nursing (CPN) Stress Questionnaire, PsychNurse Coping Questionnaire, Rosenberg Self-Esteem Scale and General Health Questionnaire GHQ-12. The study was the largest of its kind conducted in the UK. RESULTS: Data were collected from 301 CMHNs, representing a response rate of 49%. Community mental health nurses identified the most stressful issues as trying to maintain a good quality service in the midst of long waiting lists and poor resources and having too many interruptions while trying to work in the office. The best demographic predictors of high stress scores were having an unsupportive line manager, working with a specific client group and not having job security. These factors accounted for 20% of the variance in the total stress score. When the results from the psychometric instruments were included, 46% of the variance in the total stress score was accounted for. The predictive variables were emotional exhaustion, working with a specific client group, job security and alcohol consumption. CONCLUSIONS: These findings indicate that there is a need to create more supportive environments both in terms of job security and management support, especially for those working in the fields of severe mental illness and rehabilitation.

Preparing and writing an undergraduate dissertation.

Nurses studying for undergraduate degrees are often required to produce a dissertation. Usually, this will be a piece of work of around 10,000 words in length. In this paper, we discuss the characteristics of a good dissertation, and discuss a range of s trategies which students might find useful as they work towards dissertation submission. Particular areas that we concentrate on include: getting started, working with supervisors, defining aclear topic area, planning work and timetabling, locating and critiquing literature, writing up the literature review, linking theory and practice, and knitting the dissertation together.

Self-esteem and student nurses: an account of a descriptive study.

In this paper the authors describe a study of nursing students' self-reported self-esteem levels using a validated instrument: the Culture-Free Self-Esteem Inventory 2 (CFSEI-2). The research question was: How do student nurses rate their own self-esteem levels? The paper offers a short review of some of the literature, followed by a description of the sample (a convenience sample of 101 undergraduate nursing students), data collection and analysis methods and the findings. The self-esteem components of CFSEI-2 are general, personal and social and these terms are defined in the text of this paper. The findings indicated that the mean scores for this sample of nursing students fell within normal levels for all three components of self-esteem. Younger students were found to have higher scores for the social subscale, which indicates that they had a higher perception of the quality of their relationships with their peers. The findings of this study indicate that these undergraduate student nurses' perceptions of their self-esteem were comparable to the normal ranges of self-esteem as assessed by the instrument.

Coping after heart transplantation: a descriptive study of heart transplant recipients' methods of coping.

The purpose of the study reported in this paper was to explore the coping strategies of heart transplant recipients. Using a qualitative research approach, interviews were conducted with 42 participants (35 men and seven women). Analysis of the data revealed eight coping strategies: acceptance/optimism, denial/avoidance, setting targets, comparing oneself with others, making attributions, seeking social support, having faith and changing priorities and perceptions. These are discussed in relation to the literature and a tentative model of coping after heart transplantation is offered. The findings may provide pointers to health professionals about ways in which they can improve support for heart transplant recipients and their families.