Quality of life, symptom severity and level of functioning in people with severe mental illness ready for hospital discharge.

WHAT IS KNOWN ON THE SUBJECT?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern. Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries. The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre-discharge. Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital. Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Abstract Introduction There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods A cross-sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life - Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre-discharge. Results Participants reported low social relationship-related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness.

Power dynamics in the student-teacher relationship in clinical settings.

BACKGROUND: Among many factors that influence clinical learning, the teacher-student relationship has been found to be crucial. The imbalance of power in that relationship tends to be regarded as negative, but how students actually perceive the power within the relationship is unknown. AIM: This study explored nurse students' perceptions of the power dynamics in the teacher-student relationship during their clinical placement. DESIGN: A descriptive qualitative study. METHODS: A total of 51 students were recruited from a nursing school in Hong Kong. Seven focus group interviews consisted of three groups of Year 3 students (n=26) and four groups of final year students (n=25). A semi-structured interview guideline was designed. Content analysis was employed to analyse the research data. RESULTS: The three core themes that emerged from the qualitative data were: (1) meanings of power - avoiding doing harm to patients; (2) the desired power dynamics - master vs apprentice; and (3) enhancing the clinical learning experience. CONCLUSIONS: The dominant theme in the participants' discourse was that teachers should possess more power than students in order to prevent students from causing harm to patients. The consensus was that the teacher's power in supervising students' clinical practice is accepted and necessary for the benefit of patient safety. The cultural relevance of the power dynamics in the teacher-student relationship should be embraced in order to understand the student's perspective.

Uncovering nursing students' views of their relationship with educators in a university context: A descriptive qualitative study.

INTRODUCTION: Power dynamics is a key element in the educator-student relationship, and can be influential to the learning outcomes of students. BACKGROUND: Power relations are inherent in the interaction between educators and students. The educator-student relationship is still an under-explored area of power dynamics. AIM: The aim of the study was to investigate nursing students' perceptions of the power dynamics in the educator-student relationship in a university learning context in order to offer educators some understanding of how such a relationship was perceived by students. DESIGN: A descriptive qualitative study using focus group inquiry. METHODS: Through convenience sampling, a total of 56 students were recruited and eight focus group interviews were conducted. Thematic analysis was adopted to capture the meanings extracted from the student narratives. RESULTS: Four core themes of the educator-student relationship were identified. Referring to these themes, some implications were drawn, such as the significance of the educator-student relationship; an educator's power matters; and polarized views among the students on whether or not an educator should be a friend. CONCLUSIONS: The power dynamics varied depending on an educator's personality, communication skills, ability to effectively monitor large classes, and teaching style. More efforts are needed to investigate the preferred conceptions and types of educator-student relationships in order to evaluate the impact that these have on learning.

The clinical effectiveness of a multisensory therapy on clients with developmental disability.

Many clients in Hong Kong with developmental disabilities stay in mental hospitals because of mental disorders and behavioural problems. There is a need to identify strategies that promote psychological well-being and reduce problem behaviours in this group of clients. This study evaluates the impact of multisensory therapy on participants' emotional state, level of relaxation, challenging behaviour, stereotypic self-stimulating behaviour (SSB) and adaptive behaviour (AB). Using an experimental design, 89 participants were recruited from a developmental disability unit in a hospital in Hong Kong and randomly assigned to either an experimental (n = 48) or a control group (n = 41). Multisensory therapy sessions (n = 36) were conducted with experimental group and activity sessions (n = 36) were conducted with controls for 12 weeks. Multisensory therapy promoted participants' positive emotions and relaxation. However, there was no evidence that multisensory therapy was superior to activity therapy in reducing aggressive behaviour and stereotypic self-stimulating behaviour or promoting adaptive behaviour. The key variables that influence clients' behaviours in the multisensory therapy may be related to the relationship with the carer, constant environment, relaxation and freedom from demands rather than sensory input. Multisensory therapy could be used to provide leisure and promote psychological well-being, rather than for reducing problem behaviour.