What discourses shape and reshape men's experiences of accessing mental health support?

The research employs a single embodied case study design with the aim to examine the discourse of men accessing and receiving mental health support alongside those who are the providers of the support. Three groups of adults were interviewed: men who had experienced mental health problems and had attempted to access mental health support; lay people who supported them, such as partners and non-mental health professionals and professionals, such as mental health nurses, social workers, clinical psychologists and general practitioners. Critical discourse analysis (CDA) is used to identify discourses around three emergent themes: well-being, power and dominance and social capital. Participants seeking mental health support often referred to mental health services as not listening or that what was offered was not useful. A lack of belonging and community disconnectedness was apparent throughout all participant interviews. The study is reported according to the COREQ guidelines.

A protocol for exploring patients' and support peoples' experiences after prolonged critical illness.

BACKGROUND: Improved survival of critically ill people has increased the number of patients who experience an extended stay in intensive care units (ICU). Evidence suggests the complexities, vulnerabilities, and traumas created by critical illness are substantial for both patients and their support people with a number experiencing devastating impairments across multiple domains of health and function including physical, mental, cognitive, and social health. However, research on survivors predominantly focuses on those who have experienced a relatively short length of stay; only a limited number of studies seek to explore the experiences of survivors and their support people who have had a prolonged stay in intensive care. AIMS: To describe the experiences of survivors of prolonged critical illness (invasively mechanically ventilated in ICU for ≥eight days) and their support people during the first 12 months following hospital discharge in New Zealand. STUDY DESIGN: This research will be a multi-centre study recruiting from three intensive care units in New Zealand. A narrative inquiry methodology will be used to interview 6-8 former long stay patients and 6-8 support people of a former long stay patient. Each participant will be interviewed at 3-, 6-, 9-, and 12-months following hospital discharge. Data will be collected via narrative inquiry interviews. Data analysis will combine two theoretical frameworks: the Clandinin and Connelly narrative inquiry three-dimensional space and the Fairclough situation, discourse and context framework. RESULTS: The phenomenon of investigation will be experiences after prolonged critical illness explored longitudinally across the first-year post-hospital discharge. RELEVANCE TO CLINICAL PRACTICE: This protocol provides a methodological framework for exploring the lived experiences of survivors of prolonged critical illness and their support people. Data analysis will support understanding of the human journey of ICU survivorship and add to the body of knowledge on how to support post-ICU recovery in this population. The barriers and enablers of survivorship at the micro, meso, and macro levels of the health service will also be illuminated.

The long-term ICU patient: Which definition?

AIMS AND OBJECTIVES: To offer a review of the differing terminologies used by clinicians and researchers to describe the long-term intensive care unit (ICU) patient and the underlying propositions that align with this terminology. BACKGROUND: Ongoing medical and technological advances in emergency and intensive care have resulted in improved survival of critically ill patients in recent decades. In addition, these advancements have also resulted in improved survival of complex critically ill patients who progress to a trajectory of prolonged critical illness, having protracted stays in the ICU. There is great variability in terminology used to define the long-term ICU patient. This lack of a common definition for long-term ICU patients is problematic, increasing their vulnerability and risk of care not being centred about their unique needs. DESIGN: In this discursive article, we explore the terminology used to define the long-term ICU patient. An initial broad search of the literature across four electronic databases was conducted to identify common terminology used to define the long-term ICU patient. From here, seven definitions were identified and chosen for inclusion in the review as they meet inclusion criteria and clearly described a group of patients who have an extended ICU stay. The seven selected terms are as follows: prolonged mechanical ventilation; failure to wean; insertion of tracheostomy; chronically critically ill; persistent critical illness; persistent inflammatory-immunosuppressive and catabolic syndrome; and frailty. Following this a focused review of the literature with the selected terms was conducted to explore in greater detail the terminology. DISCUSSION: The lack of clear definition for this patient group can potentiate their care needs being unmet. Acknowledgement of the need to clearly define this patient group is the first step to improve outcomes. Nursing is well positioned to recognise the different terminologies use to describe this group of patients and implement care to suit their unique clinical characteristics. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Recognition and standardisation of these terms are an important priority to pave the way to improve care pathways and outcomes for this group of patients and their family.

Cultural safety and patient trust: the Hui Process to initiate the nurse-patient relationship.

The Fundamentals of Care framework is recognised for its essential elements to provide quality patient-centred care. Connection and trust as a basis for a caring relationship is a central tenet of this framework. Indigenous people of Aotearoa New Zealand face barriers to health care that are historically and socially constituted. The Hui Process is a model informed by Maori values on connection; when used to inform the Fundamental of Care framework, offers a point of entry for nursing students to develop culturally safe fundamental nursing care. We offer the use of Hui Process and the Fundamental of Care framework as an accessible approach to teach new undergraduate nursing students' relationship-based nursing through culturally safe practice and communication. The Hui Process involves four culturally safe steps; mihi, whakawhanuangatanga, kaupapa and poroporoaki Students engage with the Fundamentals of Care and the Hui Process during their introduction to nurse-patient communication, to support their first steps towards developing culturally safe nursing praxis.

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting.

The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.

Nurses' experiences of caring for patients during a prolonged critical illness.

BACKGROUND: The literature regarding nurses' experiences of caring for chronically critically ill (CCI) patients is scant, however, there are subtleties within the literature, identifying nurses are often challenged providing care to this patient group. This can lead to feeling frustrated, lack of control, and distress. AIMS AND OBJECTIVES: As part of a larger study, this paper reports nurses' experiences of caring for patients during a prolonged critical illness in the intensive care unit (ICU). DESIGN: A longitudinal, qualitative, instrumental, multi-case study consisting of six cases from four New Zealand ICUs was conducted. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. The principles of consolidated criteria for reporting qualitative research were applied in reporting the methods and findings. METHODS: Patients, family members, nurses, and other health care professionals constituted the participant groups in the larger body of work. Data were collected from observations, conversations, interviews, and document review. Data were analysed by identifying themes, developing vignettes, and trajectory mapping. RESULTS: Nurses' experiences of caring for CCI patients in the ICU can be framed by a prolonged critical illness trajectory that is unpredictable, problematic, and prolonged. Nurses experienced distress in one of the phases in the trajectory because of uncertainty about a positive outcome for the patient related to multiple complications, with anxiety, delirium, and the suffering they witnessed. Nurses were frustrated and challenged to meet all the patient's needs because of the many tasks they needed to complete over the shift. CONCLUSION: Understanding the trajectory of a prolonged critical illness from the perspective of nurses, allows for challenges to be identified and is the first step in improving practice through the education of nurses. RELEVANCE TO CLINICAL PRACTICE: Understanding the challenges posed by caring for CCI patients will assist in improving their interactions and prioritizing their care for nurses.

A qualitative multicase study of the trajectories of prolonged critical illness: Patient, family, and healthcare professionals' experiences.

BACKGROUND: Contemporary intensive care enables many critically ill patients to survive their initial illness; however, a small group of patients require a protracted stay in the intensive care unit (ICU), experiencing many complications throughout their illness. It is only when we understand the total illness experience from patients' and families' perspectives, as well as the complexity of care for healthcare professionals, that we can fully engage in developing services and promoting evidence-based practice to improve broad health outcomes and experiences for all groups. OBJECTIVE: The objective of this study was to explore the trajectories of a prolonged critical illness in an ICU from the experiences of the patient, their family, and the healthcare professionals who provide care. METHODS: This was a longitudinal, qualitative, multicase study of six cases from four New Zealand ICUs. Theoretical underpinnings were informed by the Chronic Illness Trajectory Framework. Each case consisted of the patient, their family members, and nurses and other healthcare professionals who provided care. Data collection methods included observations, conversations, interviews, and document review. Data were analysed using thematic analysis and trajectory mapping. RESULTS: Regardless of the patient's admitting diagnosis, the trajectory of a prolonged critical illness is made up of common phases, determined by the patient's physiological condition. However, all subphases represented different psychosocial needs. The patients' debilitated state made them susceptible to complications and added to the complexity of their trajectory. The family's trajectory was informed by the patient's trajectory, and uncertainty dominated throughout. Each phase of the illness presented different challenges for healthcare professionals as they cared for this complex group of patients. CONCLUSION: The study highlights the distinct phases of a prolonged critical illness. Knowledge of these phases provides the ground work for improving care, not only for patients but also for their family and the healthcare professionals who provided care.

"You can't escape it": Bullying experiences of New Zealand nursing students on clinical placement.

BACKGROUND: Bullying in nursing is not a new phenomenon and nursing students are not exempt from its effects, however there is limited literature that deals directly with bullying of nursing students within the clinical environment in New Zealand. Quality clinical placements are vital to facilitate the link between theory and practice whilst working in complex healthcare settings. AIM: The purpose of this article is to present the experiences described by nursing students regarding the nature and extent of bullying during clinical placements. DESIGN: This study employed a cross-sectional survey design using an electronic survey in which this paper focuses on the textual data provided by nursing students from across New Zealand. Data was analysed by coding and grouping into themes. RESULTS: There were numerous uncivil behaviours students were subject to during clinical placements. The consequences of these behaviours had physical, psychological and financial implications for students, with some suggestions that they choose to leave the nursing profession. CONCLUSIONS: Predominantly the practice setting is clearly not nurturing enough for nursing students; a situation unlikely to change in the near future. Hence academic institutions must be proactive in developing students' ability to address incivility in these environments and to educate their own staff on how to recognise and respond to bullying in the clinical arena.

A multicase study of prolonged critical illness in the intensive care unit: Families' experiences.

BACKGROUND: It is widely acknowledged a critical illness is a stressful life event for not only the patient but also their family members; when an illness becomes prolonged, the impact is profound. It is suggested that as medical technologies advance, the number of days patients stay in an intensive care unit will increase. Therefore, it is important nurses understand how families experience a prolonged critical illness of their family member in an intensive care unit. OBJECTIVE: To explore the trajectory of a prolonged critical illness in the intensive care unit from the experiences of family. METHODS: A qualitative, longitudinal, multi-case design consisting of six cases from New Zealand intensive care units. Findings presented in this article only relate to the family's experiences, although patients and healthcare professionals formed part of each case. Data collection methods included observation, conversations, interviews and document review. Analysis was undertaken using thematic analysis, vignette development and trajectory mapping. FINDINGS: Relentless uncertainty dominated all phases of the trajectory for the family during a family member's prolonged critical illness in the intensive care unit. When faced with a critical illness, family shifted rapidly into a world of unknowns. Family worked hard to navigate their way through the many uncertainties that dominated each phase of their family member's illness. CONCLUSIONS: Nurses need to understand the levels of uncertainty families endure in order to provide care that meets the philosophical underpinnings of family centred care.

The impact of a prolonged stay in the ICU on patients' fundamental care needs.

AIMS AND OBJECTIVES: To explore patients', families' and health professionals' experiences of a long-stay patient in an intensive care unit. BACKGROUND: The fast-paced technologically driven intensive care unit environment, designed for a short patient stay, supports the provision of complex physiologically focused care for those with life-threatening illnesses. Long-stay patients with pronounced fundamental care needs fall outside predicted patient pathways, and nurses can find caring for these patients challenging. DESIGN AND METHODS: A longitudinal, qualitative, multicase study of six cases from four New Zealand units. Case participants were patients, family members, nurses and other health professionals. Data collection methods included observation, conversations, interviews and document review. Data were analysed using thematic analysis, vignette development and trajectory mapping. RESULTS: Challenges and successes of providing fundamental care for long-stay ICU patients are attributed to two interlinked factors. First, the biomedical model influences ICU nursing practices, resulting in prioritising tasks and technology for patient survival while simultaneously devaluing relational and comfort work. Fundamental psychosocial needs such as family presence, comfort, relationships and communication may be unmet. Second, the unit environment and culture have a significant impact on long-stay patients' ICU experiences and form physical and psychological barriers to families being present and involved. Some nurses negotiated these challenges to provide fundamental, patient- and family-centred care by adopting an approach of knowing the patient and these nurses reported satisfaction when seeing patients' positive responses. CONCLUSION: The care environment and culture provide challenges to the provision of patient- and family-centred care for long-stay patients; however, when nurses prioritise knowing their patient these challenges can be overcome and patient and family distress reduced with the potential to improve patient outcomes. RELEVANCE TO CLINICAL PRACTICE: Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes.

Rethinking the intensive care environment: considering nature in nursing practice.

AIMS AND OBJECTIVES: With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. BACKGROUND: The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. DESIGN: This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. METHODS: Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. CONCLUSION: There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. RELEVANCE TO CLINICAL PRACTICE: Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes.

Memories of former intensive care patients six months following discharge.

This exploratory/descriptive study describes the memories of former ICU (Intensive Care Unit) patients after discharge. Six patients described their memories of ICU and discharge to the ward and home. Memories for the former ICU patients varied, and there were multiple layers of awareness, with periods of unreal experiences and nightmares. In the memories collected, there was little reference to nurses, or connection to the care they provided. Once discharged from ICU, patients' memories changed to new challenges they faced as they coped with the realization of how sick they had been and tried to regain control of their lives. This small-scaled study has identified some areas of practice that could be improved and further research requirements.