Exploring individuals' experiences of hope in mental health recovery: Having a sense of possibility.

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery is acknowledged as a process of transformation and a way of living a meaningful life despite the presence of mental ill-health. Experiencing hope has been articulated as intrinsic to service users experience of a meaningful life. The social construction of mental illness and stigma are recognised as barriers to experiencing hope. Mental health professionals have responsibility to positively influence the experience of hope. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: Individuals in mental health recovery experience hope as the embodiment of having a sense of possibility in life. Individuals' sense of possibility in life is underpinned by a belief and confidence that they will be ok. This belief is informed by 'feeling safe' and 'feeling connected'. This article generates an increased understanding of the dynamic relational processes that unpin hope generation. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health stakeholders need to be more explicit in exploring 'hope' and uncovering its therapeutic potential. Mental health practitioners need skill in enabling individuals to feel safe and connected while understanding its role in cultivating hope. ABSTRACT: Introduction The experience of hope is widely acknowledged and empirically supported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative Interpretative Phenomenological Analysis (IPA) approach was used. Results This article explores the second of three experiential group themes: Hope as Having a sense of possibility 'I will be ok' which is informed by feeling safe and feeling connected. Discussion Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and healthcare professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant. Implications for Practice It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

Factors related to the quality of life of older prisoners.

PURPOSES: There is evidence of an increasing emphasis on the relevance of the quality of life-paradigm as an outcome measure for clients in geriatric, forensic, as well as correctional care. This paper aims to explore to what extent variables that were categorized according to the main areas of the Good Lives Model ('the self', 'the body' and 'social life') are related to the quality of life domains of older imprisoned offenders. METHODS: Data were collected by means of a structured questionnaire administered in individual interviews with 93 older prisoners aged 60 years and over in 16 prisons of the Dutch-speaking region in Belgium. Characteristics of the main GLM-areas were identified by specifically designed items as well three validated instruments (psychiatric disorders, loneliness, and frailty). Dependent variables consisted of the four sub-domains of the WHOQOL-BREF instrument which measures quality of life in four domains, namely: (1) physical health, (2) psychological health, (3) social relationships, and (4) environment. Structural equation modelling (SEM) was used for statistical analysis. RESULTS: Individual variables, such as satisfaction with activities, were related to the older prisoners' QoL in several domains simultaneously. Other than suicidal ideation, psychopathological symptoms had no significant relation to quality of life. CONCLUSIONS: Approaches enabling older prisoner to disclose their interests, experiences, and feelings are important in prison. Special attention should be given to psychiatric and age-related symptoms of older prisoners, since they may not be noted by the prison staff, as older prisoners seem to be poorer self-advocates as compared to their younger peers.

Older offenders deemed criminally irresponsible in Flanders (Belgium): Descriptive results from a retrospective case note study.

INTRODUCTION: In Belgium, offenders who are deemed criminally irresponsible for their criminal actions because of mental illness or intellectual disability are subject to a specific safety measure with the dual objective of protecting society and providing mandated care to the offender. While Belgian law requires that offenders who are deemed criminally irresponsible should be in a hospital, clinic or other appropriate institution outside of prison, in practice, about one-third of all such offenders still reside in prison. Whether imprisoned or living in settings outside prison, there is a dearth of knowledge on the characteristics of the aging population among the criminally irresponsible offenders. OBJECTIVE: This paper aimed to explore the characteristics of older offenders categorized as criminally irresponsible in Flanders (northern Belgium) with a focus on the differences between imprisoned older offenders deemed criminally irresponsible and their peers who are residing outside prison. METHOD: A retrospective case note study of all offenders deemed criminally irresponsible, >60years of age (n=174), was conducted in the four Commissions of Social Defense, which implement the procedure in the case of those deemed criminally irresponsible in Flanders. The files were screened for (1) demographic characteristics, (2) criminal history as well as (3) mental and physical health issues. RESULTS: One-fourth of the population were >70years of age. A total of 30.5% were in prison. Compared to their non-imprisoned peers, the imprisoned offenders had a history of having committed more serious violent crimes towards persons, such as homicides and sexual crimes. In addition, imprisoned older offenders categorized as criminally irresponsible are characterized more explicitly by personality traits that are likely to reduce their chances of being transferred to more appropriate settings in the community. IMPLICATIONS: A comprehensive and systematic screening of all older offenders deemed criminally irresponsible with regard to health needs and social functioning, including age-related deterioration, alcoholism, and other causes of social disadvantages, is warranted to detect potentially hidden problems.

Treatment and Control: A Qualitative Study of Older Mentally Ill Offenders' Perceptions on Their Detention and Care Trajectory.

The life of older mentally ill offenders (OMIOs) is often characterized by successive periods of detention in correctional facilities, admissions to psychiatric services, and unsuccessful attempts to live independently. Through in-depth interviews, eight personal stories from OMIOs under supervision of the commission of social defence in Ghent (Belgium) were analyzed in the phenomenological research tradition. The results of the study reveal that OMIOs had more positive and less negative experiences in prison settings when compared with other institutional care settings. Independent living, unsurprisingly, is favored the most. This may be due to the fact that the latter option fosters personal competence, feelings of being useful, personal choices, and contact with the "outside" world. Even in later lifetime, a combined approach of risk assessment with improvement of well-being remains valuable to stimulate offender rehabilitation. Therefore, more research into concepts that could be used to support OMIOs needs further consideration.

Evaluation of mental health recovery and Wellness Recovery Action Planning education in Ireland: a mixed methods pre-postevaluation.

AIM: To report a study evaluating the effectiveness of a Wellness Recovery Action Planning education programme. BACKGROUND: Internationally, mental health policy is advocating using recovery approaches to care. Underpinning these approaches is investment in education in recovery principles and methods and a need to provide evidence of the impact of this education. DESIGN: The study design employed a mixed methods approach. METHODS: Using questionnaires and focus groups, we evaluated 2- and 5-day Wellness Recovery Action Planning Education Programmes and assessed participants' attitudes towards recovery, knowledge of recovery and Wellness Recovery Action Planning beliefs. Data were collected between 2009 and 2010. Participants were people with personal experience of mental health problems, practitioners in mental health services and family members/carers of those with mental health problems. RESULTS: Comparing the pre and postmeasures showed that the programme increased participants' knowledge of and attitudes towards recovery and Wellness Recovery Action Planning. Although this increase was statistically significant for the 2-day programme, it was not so for the 5-day programme. Participants reported being very positive and enthusiastic about the programme and the benefits they had achieved personally and professionally as a result of participating. CONCLUSIONS: This exploratory study shows that providing mental health practitioners and people with personal experience of mental health problems with a systematic education and training in recovery principles using the Wellness Recovery Action Planning approach leads to positive changes in people's knowledge, skills and attitudes towards recovery. This education appeared to inspire, invigorate and empower people, and for many, it was a life changing experience.

Assessment of biological activity of novel peptide analogues of angiotensin IV.

OBJECTIVES: Angiotensin IV (Ang IV) is a metabolite of angiotensin II which acts on specific AT(4) receptors identified as the enzyme insulin regulated aminopeptidase (IRAP). The transduction process of these receptors is unresolved, but Ang IV inhibits the aminopeptidase activity. Ang IV improves cognition in animal models thus there is a desire to develop metabolically stable analogues for further development. METHODS: Peptide analogues of Ang IV were obtained commercially or synthesised. Each peptide was tested in vitro for its ability to inhibit the aminopeptidase activity (IRAP) of mouse brain homogenates and for its effects on isolated rat uterine smooth muscle. KEY FINDINGS: [Des-Val(1) ]-Ang IV, acetylated-Ang IV-amide, Ang IV-amide and [des-His(4) ]-Ang IV all inhibited IRAP. [Sar(1) , Ile(8) ]-Angiotensin II (10 µm) had an effect greater than that of Ang IV or any of the other analogues studied. In isolated uterine smooth muscle, angiotensins II and IV induced contractions, which could be antagonised by an AT(1) -receptor antagonist. None of the novel peptides induced uterine smooth muscle contractions, but [Sar(1) , des Arg(2) -Gly(8) ]-angiotensin II showed significant antagonism of the contractile effects of angiotensin II and carboxyamide-terminated Ang IV-NH(2) showed antagonism of Ang IV-induced contractions. CONCLUSIONS: This study provides five novel inhibitors of IRAP worthy of assessment in behavioural models of learning and memory. The analogues are devoid of AT(1) receptor agonist properties, and the carboxyamide analogue presents an opportunity to elucidate the mechanism of action of Ang IV as, like Ang IV, it inhibits IRAP, but antagonises the effects of Ang IV on isolated smooth muscle.

Inward labour mobility in the Irish health- and social-care sector.

In an effort to understand the factors that impinge on labour mobility in the health- and social-care sector in Ireland, an exploratory study was undertaken. This study involved key organizational stakeholders and individual practitioners in the health- and social-care environment. A qualitative design using purposive sampling was employed, involving face-to-face and telephone, semi-structured interviews. Four interviews were undertaken with representatives from the Irish Nurses' Organization, the Health Services Executive, the Department of Health and Children, and the Association of Social Workers. Interviews were also undertaken with five health-care professionals who had relocated to Ireland. Notes were taken during all the interviews, and respondents were then sent copies of the transcripts to verify accuracy. Data analysis was guided by Burnard's (1991) framework. The data were analysed according to emerging categories and subcategories. Data emerged in relation to reasons for work mobility, the factors that support mobility and the factors that inhibit it. The reasons for moving to Ireland were mostly personal, professional or economic. In addition, factors facilitating movement included having established contacts in the country, organizational support and the attractiveness of educational structures. Challenges included the recruitment process itself, organizational support structures, professional recognition, language barriers and social integration. The findings are discussed in terms of health and social policy.

Third-level nurse education: learning from the Irish experience.

Nursing and nurse education is rapidly changing internationally. The profession and the different branches of practice have moved in a relatively short period of time from a 'handmaiden' status to have an evolving professional standing as equal members of interdisciplinary teams. This has coincided with the evolving trend to locate nurse training programmes within the higher education sector. Differing models of nurse preparation exist internationally, but there is an inexorable trend to higher education. Ireland has moved away from traditional 'hospital-based' schools of nursing in the past decade or so to a system of universal preparation of nurses within higher education structures. Unlike many other countries, entry to any branch of nursing in Ireland now requires honours degree level education. It seems timely, therefore, to consider the lessons that can be learned from this development and consider the key challenges that face nursing, the healthcare system and the higher education system as a result of this development.

Experience of stress in psychiatric nursing students in Ireland.

AIM: The aim of this study was to explore the experience of stress among psychiatric nursing students undertaking their 'internship' or final year of a four-year degree course. METHOD: A questionnaire was administered to all 28 students in the intern year in conjunction with the 28-item version of the General Health Questionnaire. Semi-structured interviews were subsequently undertaken with four volunteers from a range of clinical locations. FINDINGS: Approximately 48% of respondents reported levels of stress above the threshold score as described by Goldberg (1978), indicating levels of distress unlikely to remit without intervention. Interview data suggested that the main sources of stress during the intern year were associated with relationships in the clinical environment; clinical workload; matching competence and responsibility; and simultaneous clinical and academic demands. CONCLUSION: The findings should be interpreted with caution and understood within the context of the dynamic nature of nurse education in Ireland. However, the issues raised demand further enquiry to examine the structure of educational programmes, the nature of the work and the organisational culture in which the work is carried out.

Aggression and violence - a problem in Irish Accident and Emergency departments?

Health care employees are more likely than other workers to be victims of violence or aggression. Results from one Australian study suggest that 30% of respondents experienced aggression on a daily or near daily basis. In an Irish context, a total of 22% of all reported injuries in the health and social sector related to injuries inflicted by another person. However, both in Ireland and internationally, there has been an inadequate categorization of the types of incident to which staff are exposed. This contributes to definitional difficulties as well as problems in comparing research findings and using such findings to make work environments safe. The current study aimed to identify the types of violent or aggressive incidents that staff in Irish Accident and Emergency departments were exposed to within a month long period. A cross-sectional study was undertaken with all nurses (N = 80) working in Accident and Emergency departments in two sites nationally as part of a larger study of aggression and violence in health services looking at both Mental Health Services and Accident and Emergency departments. Data were collected using the Scale of Aggressive and Violent Experiences - questionnaire adapted from the Perception of Prevalence of Aggression Scale. The questionnaire captured data on personal and professional demographics as well as experiences of aggressive or violent incidents respondents may have encountered 'in their work situation'. There was a response rate of 46% (n = 37). Data were analysed utilizing spss-11. The relevant data were subjected to a series of one-way anovas and chi-square analysis. The findings suggest that nursing staff in Accident and Emergency departments experienced high levels of verbal aggression. Additionally, they encountered violence or aggression that is vicariously experienced more than forms that were overtly directed towards staff. It is a matter of concern that less than one-third of staff in this study reported that they had training in the management of aggression and violence. The implications will be discussed in relation to both policy and practice.