Patient experiences with nursing care during hospitalization on a closed ward due to a manic episode: A qualitative study.

PURPOSE: To describe the experiences of patients with nursing care they had received when hospitalized for mania. DESIGN AND METHODS: Multicenter qualitative study using open interviews. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: Sense of security is vital for the recovery of these patients, nurses can support and hinder this. Feelings of security are related to clear and calm communication, respect, recognizability of nurses, and daily structure. PRACTICE IMPLICATIONS: Nurses should make sure that the patient recognizes them as nurses. Nurses should spend as much time as possible in the living room. Clear communication about treatment goals is important.

Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography.

Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder. Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation. Methods: Medical records (n = 100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview. Findings: Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants' ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review. Conclusions: The rendering of an appropriate diagnosis is key. Many participants' lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.

A document analysis of how the concept of health is incorporated in care plans when using the nursing diagnosis classification system (NANDA-I) in relation to individuals with bipolar disorder.

INTRODUCTION: Nursing diagnosis classification systems have been developed to help nurses identify problems and patient needs. However, the question of how classification systems have adopted the concept of health has been given little attention. AIM: The aim was to explore and analyse which perspectives on health are incorporated into the NANDA-I-based care plans of individuals with bipolar disorder. METHODS: A document analysis was used to systematically review and analyse care plans based on nursing diagnosis classification system. Thematic analysis was used as an analytic tool. FINDINGS: The results are presented in three themes: (i) health as strengths; (ii) health as satisfaction; and (iii) health as behaviour and functionality. DISCUSSION: We discuss how health is deeply embedded in nursing diagnosis classification system-based care plans. The care plans correspond to the holistic perspective, as they acknowledge the existence of health even during illness. Further, health is viewed as nonstatic and discussed from the perspective of person-centred care.

Risk of Posttraumatic Stress Disorder and Its Relationship With Perceived Social Support Among Family Caregivers of Individuals With Schizophrenia or Bipolar Disorder.

A cross-sectional descriptive correlation study was performed to investigate the risk of posttraumatic stress disorder (PTSD) among 300 family caregivers of individuals with schizophrenia or bipolar disorder and examine the relationship between perceived social support and risk of PTSD. The Arabic version of the PTSD Checklist for DSM-5 (APCL-5) was used to investigate risk of PTSD; the Arabic version of the Multidimensional Scale of Perceived Social Support was used to measure perceived social support. Mean score of the APCL-5 was 46.1, indicating risk of PTSD among family caregivers. A negative moderate correlation was found between risk of PTSD and perceived social support. The caring process is demanding and highly stressful, putting family caregivers at risk for PTSD. Social support is crucial in decreasing this risk. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 37-43.].

Understanding the role of m-health to improve well-being in spouses of patients with bipolar disorder.

OBJECTIVES: Spouses and partners of individuals with bipolar disorder (BD) experience significant burden. As there are some limitations to standard psychosocial caregiver interventions, mobile health technology (mHealth) may be a way to reduce burden and improve well-being in these caregivers. The purpose of this study was to explore how the well-being of spouses or partners of patients with BD can be improved through mHealth technology. METHODS: Using a qualitative design, we conducted five focus groups and one in-depth individual interview to collect information from participants about what they would expect from such a device. The sample consists of thirteen participants (eleven spouses and two partners). The age range was 29-65, with eight females and five males. Data were collected using minimally structured interviews and independently analyzed by the authors using content analysis. RESULTS: Results indicated that the mHealth device many be helpful in at least six areas: reduction of stressors, decreased social isolation, improving communication in the relationship between the spouses, speaking with children about the illness, managing medications, and providing information on resources. CONCLUSION: Mobile health technology may be a feasible, available, and cost-effective support tool for spouses and partners of individuals with BD, especially in reducing caregiver stress. Future research is needed to develop the application and test its effectiveness on health outcomes in a larger trial.

Caregivers experiences of nursing care for relatives hospitalized during manic episode: A phenomenological study.

PURPOSE: To describe the experiences of informal caregivers with the nursing care received by relatives hospitalized for mania. DESIGN AND METHODS: Multicenter phenomenological study using open interviews. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: The essence of the experiences was the importance of communication, about being informed and involved in treatment during hospitalization of their relative. The experiences depended on the nature of the relation between participant and relative. PRACTICE IMPLICATIONS: Nurses should listen to caregivers' experiences, inquire about the expectations of caregivers regarding nursing care, and advise informal caregivers on how to take care of their relatives.

Características demográficas, de salud, necesidades de cuidado y diagnósticos de enfermería de personas hospitalizadas que sufren trastorno afectivo bipolar / Demographic and Health Characteristics, Care Needs and Nursing Diagnoses in Hospitalized Individuals with Bipolar Affective Disorder / Características demográficas, de saúde, necessidades de cuidado e diagnósticos de enfermagem de pessoal hospitalizado sofrendo transtorno afetivo bipolar

Introducción: el trastorno afectivo bipolar (TAB) es una enfermedad mental crónica más frecuente en mujeres que en hombres. La prevalencia en el mundo es del 1% y en Colombia es del 1,2%. Objetivo: Describir las características demográficas, de salud, necesidades de cuidado y diagnóstico de enfermería en pacientes que ingresan a hospitalización con un diagnóstico de TAB a la Clínica Psiquiátrica Nuestra Señora del Sagrado Corazón. Método: Estudio descriptivo retrospectivo. Se seleccionaron 158 historias clínicas entre enero y junio de 2015, La información se recolectó de las notas de ingreso del equipo terapéutico, y para las necesidades de cuidado se utilizaron los patrones funcionales de Marjory Gordon. Resultados: el 55,7% eran mujeres, con edades entre 19 y 82 años, el 71,5% eran residentes de Medellin, el 47,5% eran solteros, el 19% tenían estudios secundarios. El 66,5% presentó sintomatologia propia del TAB en el momento del ingreso; el diagnóstico CIE-10 más frecuente fue TAB-episodio maniaco, presente con síntomas psicóticos. Las necesidades encontradas, según los patrones de Marjory Gordon, fueron: falta de introspección, presencia de insomnio, alucinaciones y autoagresión. Para estas necesidades los diagnósticos de enfermería fueron: deterioro de la toma de decisiones independiente, trastorno del patrón del sueño y riesgo de violencia autodirigida. Conclusiones: La información demográfica y de salud es similar a las características reportadas por otras investigaciones. Tanto las necesidades de cuidado y los diagnósticos de enfermería son congruentes con la incapacidad mental que impiden un adecuado autocuidado.

Introduction: Bipolar Affective Disorder (BAD) is a chronic mental illness more frequently found in woman than in men. The prevalence over the world is 1% and in Colombia is 1.2%. Objective: To describe the demographic and health characteristics, care needs and nursing diagnoses in patients hospitalized due to a BAD diagnosis in the mental-health clinic Clínica Psiquiátrica Nuestra Señora del Sagrado Corazón. Method: This is a retrospective descriptive study. One hundred and fifty-eight medical records were selected between January and June 2015. Information was gathered from the admission notes by the therapeutic team; the functional patterns by Marjory Gordon were used to examine the care needs based on the data. Results: In the sample, 55.7%were women from 19 to 82 years old; 71.5% of the sample lived in Medellin; 47.5% were single individuals; 19% had completed the high school. A 66.5% showed symptoms typical to the BAD at the time of admission; under the CIE-10 diagnosis, the BAD maniac episode was the most frequent and included psychotic symptoms. According to the patterns by Marjory Gordon, the nursing needs found in the sample were: lack of introspection, sleeplessness, hallucinations, and selfharming. Regarding these needs, the nursing diagnoses were: deterioration in the independent decision-making; disorder of the sleep pattern and self-harming risk. Conclusions: The demographic and health information is similar to the typical characteristics reported in other researches. Both the care needs and nursing diagnoses are consistent with the mental inability, which hampers an appropriate self-care.

Introdução: O transtorno afetivo bipolar (TAB) é uma doença mental crônica mais frequente em mulheres do que em homens. A prevalência no mundo é de 1 % e na Colômbia é de 1,2%. Objetivo: Descrever as características demográficas, de saúde, necessidades de cuidado e diagnóstico de enfermagem em pacientes internos com diagnóstico de TAB na Clínica Psiquiátrica Nuestra Señora del Sagrado Corazón. Método: Estudo descritivo retrospectivo. Selecionaram-se 158 relatórios clínicos entre janeiro e junho de 2015. A informação foi coletada das anotações de admissão da equipe terapêutica, e para as necessidades de cuidado foram utilizados padrões funcionais de Marjory Gordon. Resultados: 55,7% foram mulheres, com idades entre 19 e 82 anos, 71,5% foram residentes em Medellin, 47,5% solteiros, 19% tinham ensino médio. 66,5% apresentou sintomatologia própria do TAB no momento do ingresso; o diagnóstico CIE-10 mais frequente foi TAB-episódio maníaco, presente com sintomas psicóticos. As necessidades encontradas, de acordo com os padrões de Marjory Gordon, foram: falta de introspeção, presença de insônia, alucinações e autoagressão. Para tais necessidades os diagnósticos de enfermagem foram: deterioração da tomada de decisões independente, transtorno do padrão de sonho e risco de violência autodirigida. Conclusões: As informações demográficas e de saúde são semelhantes às caraterísticas relatadas por outras pesquisas. Tanto as necessidades de cuidado quanto os diagnósticos de enfermagem são congruentes com a incapacidade mental que impede um adequado autocuidado.

[Evolution of the levels of the caregiver burden in bipolar patients' family members who participated in a psychoeducational workshop]. / Evolución de los niveles de sobrecarga del cuidador en familiares de pacientes bipolares que participaron de un taller de psicoeducación.

PURPOSE: Caregiver burden is a variable which measures the impact of a chronic disease on the people who are closer to the patient. Different investigations have shown that the burden suffered by family members of patients with bipolar disorder is similar to that suffered by the relatives of schizophrenic patients and superior to the excessive strain caused by chronic diseases, such as diabetes. Lowering burden levels has been proved to improve family members' welfare and also to reduce patients' relapse indexes. This research accounts for the diminution in the burden endured by family members who participated in a psychoeducational workshop which included an "expert patient" in the coordinators team. METHODS: Zarit scale for assessment of caregiver burden was used at three stages: at the beginning of the workshop (n=95), at the end of the workshop (n=64) and three months later by a follow-up (n=34). RESULTS: The percentage of participants with overburden was reduced from a 75 % in the first sample taken to a 63% in the last one with a significant fall in the intense burden. CONCLUSIONS: The study has succeeded in showing that there was a reduction in the burden. However, it could not prove whether the results came as a consequence of the intervention model or as the natural evolution of the burden over the course of time. We have been advancing in further investigations which will shed light on these variables.

Burden on caregivers of older patients with bipolar disorder.

OBJECTIVES: Available data suggest high burden on caregivers of patientswith bipolar disorder (BD), yet the well-being of patients with BD increasingly depends on family members, partners and close friends. Aspatients with BD get older, the need for informal care may shift. We aimed to describe the caregivers of older adults with BD (OABD) and explore what patients' and caregivers' characteristics are associated with caregiver burden. METHOD: Forty-seven caregivers of OABD were questioned about their perceived burden and depressive symptoms. Linear regression analyses were performed to examine the influence of various patients' and caregivers' characteristics on caregiver burden or depression. RESULTS: More than half of all caregivers experienced some degree of burden,and 6.4% reported depressive symptoms. The number of psychiatric admissions and social functioning were the only patients' characteristics associated with higher burden. Caregiver burden was significantly associated with caregiver's other obligations. None of the patient or caregiver characteristics was significantly associated with depression in caregivers of OABD. CONCLUSION: In OABD, even with few residual symptoms, more than half of all caregivers experience substantial burden. Future studies are needed to confirm if improving social functioning and preventing psychiatric hospitalizations decrease the burden on the caregivers of OABD.

Randomized, controlled trial of a brief family-centred care programme for hospitalized patients with bipolar disorder and their family caregivers.

Family interventions have been emphasized in the treatment of bipolar disorder (BPD) due to the bidirectional and entangled relationships between patients and the family system, and have benefits for patients' symptoms and health; however, the effects of family interventions on family function and caregivers' health-related outcomes have not been well investigated. This randomized, controlled trial with 47 hospitalized patients with BPD/family caregiver dyads at a medical centre in northern Taiwan compared the effects of a brief family-centred care (BFCC) programme with treatment as usual (TAU). All of the family caregivers in two groups were invited to attend a routine 60-min family discussion group about violence and suicide prevention. The TAU group without specific family interview for patient and family caregiver dyad. In the BFCC group, four 90-min BFCC programme sessions were additionally provided twice a week for each hospitalized family dyad. We hypothesized that, first, family caregivers in the BFCC group could increase their family function, and second, improve perceived health status and reduce caregiver's burdens compared to the TAU. The results showed that family caregivers in the BFCC group significant interaction effects in overall family function (P = 0.03) and subscale conflict (P = 0.04), communication (P = 0.01), and problem-solving (P = 0.04), but there were no significant interaction effects on the caregivers' perceived health status and caregivers' burdens. Our findings support both the feasibility of using the BFCC programme for inpatients and its specific benefits for family function. An intensive family intervention during hospitalization has been suggested in psychiatric practice to support patients with BPD and family caregivers.

Positive Aspects of Caregiving and Its Correlates among Caregivers of Bipolar Affective Disorder.

OBJECTIVE: To evaluate the positive aspects of caregiving and its correlates (socio-demographic and clinical variables, caregiver burden, coping, quality of life, psychological morbidity) in the primary caregivers of patients with bipolar affective disorder (BPAD). METHODS: A total of 60 primary caregivers of patients with a diagnosis of BPAD were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE) and the Hindi version of Involvement Evaluation Questionnaire, Family Burden Interview Schedule (FBIS), modified Hindi version of Coping Checklist, shorter Hindi version of the World Health Organization Quality of Life (WHOQOL-BREF), and Hindi translated version of 12-item General Health Questionnaire (GHQ-12). RESULTS: Caregivers of patients with BPAD had the highest mean score in the SPACE domain of Motivation for caregiving role (2.45), followed by Caregiver satisfaction (2.38) and Caregiving personal gains (2.20). The mean score was the lowest for the domain of Self-esteem and social aspect of caring (2.01). In terms of correlations, age of onset of BPAD had a negative correlation with various domains of SPACE. The mean number of total lifetime affective and depressive episodes correlated positively with Self-esteem and social aspect of caring. Caregiver satisfaction correlated negatively with FBIS domains of Disruption of routine family activities, Effect on mental health of others, and subjective burden. Coercion as a coping mechanism correlated positively with domains of Caregiving personal gains, Caregiver satisfaction, and the total score on SPACE. Three (Physical health, Psychological health, Environment) out of 5 domains of the WHOQOL-BREF correlated positively with the total SPACE score. No association was noted between GHQ-12 and SPACE scores. CONCLUSION: Positive caregiving experience in primary caregivers of patients with BPAD is associated with better quality of life of the caregivers.

[Care of Individuals With Bipolar Disorders].

Bipolar disorder (BD) is a severe mental illness that is characterized by chronicity, pervasive instability, and relatively high rates of recurrence and suicide. Current evidence supports that adverse circles among hereditary and genetic factors, neuroinflamation, and social rhythm constitute a crucial etiology. Pharmacological treatment is the first priority for BD patients during the acute stage. Pharmacological and psychosocial treatments should be combined during the maintenance stage in order to help patients self-manage medication, effectively control mood swings, enhance disease self-management and social functions, decrease the risks of relapse and re-hospitalization, and stabilize overall health. The present article firstly introduces the characteristics and etiological assumptions related to BD, the related evidence-based care models and their effects, and the early development of an evidence-based care model, the BalancingMySwing group, for BD patients in Taiwan. This article provides updated information to clinicians who are involved in caring for this population. Moreover, the existing data related to biological and psychosocial factors for BD in Taiwan is insufficient and developing individual-tailored psychosocial intervention is urgently needed. The authors hope that this article will elicit greater concern for this issue from policy decision-makers and healthcare providers.

Comparing Affiliate Stigma Between Family Caregivers of People With Different Severe Mental Illness in Taiwan.

The family caregivers of people with mental illness may internalize the public stereotypes into the affiliate stigma (i.e., the self-stigma of family members). This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (ß = -0.109; p < 0.05) and major depressive disorder (ß = -0.230; p < 0.001). Self-esteem, developmental burden, and emotional burden were significant factors for affiliate stigma. The affiliate stigma of caregivers is associated with their self-esteem, caregiver burden, and by the diagnosis.

Psychological Correlates of Burden Among Jordanian Caregivers of Patients With Serious Mental Illness.

PURPOSE: To examine prediction power of personality traits, expressed emotion, and coping strategies on caregivers' burden. DESIGNS AND METHODS: Cross-sectional descriptive correlational design was used to collect data from 196 caregivers using the Self-Administered Questionnaire from Jordanian caregivers of patients with serious mental illness. FINDINGS: Jordanian caregivers had a moderate-to-severe burden level (M = 47.1, SD = 11.5). Burden had a significant negative relationship with coping (r = -.15, p = .04) and significant positive relationship with personality dysfunction (r = .16, p = .021). Emotional expression, coping, and personality were found to be significant predictors of burden (F = 5.16, p = .002). PRACTICE IMPLICATIONS: Mental health professionals need to address family caregivers in their plans of care.

Assessment and Care of Childbearing Women With Severe and Persistent Mental Illness.

Severe and persistent mental illness (SPMI) refers to complex mood disorders that include major depressive disorder with or without psychosis; severe anxiety disorders resistant to treatment; affective psychotic disorders including bipolar affective disorder, schizophrenia, and schizoaffective disorder; and other nonaffective subtypes of schizophrenia. SPMIs affect 1 in 17 people and are among the leading causes of disability and impaired health-related quality of life in the United States. Caring for childbearing women with preexisting SPMI can be challenging for maternal-child health clinicians. This article provides an overview of SPMI during pregnancy and challenges for clinicians, including early identification, accuracy of diagnoses, and appropriate management through care coordination among an interdisciplinary team that includes obstetric providers, psychiatrists, nurses, and others.

Comparison of burden among family members of patients diagnosed with schizophrenia and bipolar disorder in a large acute psychiatric hospital in China.

BACKGROUND: The difference of burden between caregivers of acute patients with schizophrenia and bipolar disorder has not been well studied in China, a culture where family responsibility has a very high value. Our aim is to compare family burden in these two categories diagnosis and to identify predictors of family burden in a large psychiatric hospital in China. METHODS: Two hundred forty-three schizophrenic patients and 200 bipolar patients were enrolled in a cross-sectional study. Patients were independently evaluated on symptoms, insight, attitudes toward medication, quality of life during the first week of their admissions. The prime caregiver for each patient was also evaluated with a standard measure of family burden within 1 week of patients' admission. RESULTS: Caregiver perceptions of violent behavior and suicidal risk among patients with bipolar disorder were significantly greater than among families of those with schizophrenia. Hierarchical regression analyses demonstrated differential correlates of burden for all predictive factors with R(2) values ranging from 0.14 to 0.27 in the five burden factors in schizophrenia families; and from 0.12 to 0.24 in bipolar disorder families. Symptoms severity explained the greatest proportion of variance, whereas patient and caregiver demographic variables explained much less variance. CONCLUSION: Family burden, especially the caregiver perceptions of violent and suicidal behaviors were greater in care givers of acute bipolar disorder patients than among caregivers of schizophrenia patients in the present sample. However, in families of patients with both disorders clinical features were the strongest predictor of caregiver burden.

Contemporary Treatment Approaches to Major Depression and Bipolar Disorders.

Mood disorders have a high incidence of coexisting psychiatric, substance use, and physical disorders. When these disorders are unrecognized and left untreated, patients are likely to have a reduced life expectancy and experience impaired functional and psychosocial deficits and poor quality of life. Psychiatric nurses are poised to address the needs of these patients through various approaches. Although the ideal approach for mood disorders continues to be researched, there is a compilation of data showing that integrated models of treatment that reflect person-centered, strength, and recovery-based principles produce positive clinical outcomes.

The role of family interventions in bipolar disorder: A systematic review.

The reciprocal relationship between bipolar disorder (BD) and the family system highlights the importance of adjunctive family intervention. However, its implementation in clinical practice is not widespread. To update the knowledge in this field and identify areas of uncertainty this manuscript present a comprehensive overview of the bidirectional relationship between BD and family variables, and a systematic review of the evidence-based studies published up to March 2015 on the efficacy of adjunctive family intervention in BD. Findings show that not only specific family's attitudes/interactions affect the course of BD but that equally the illness itself has a strong impact on family functioning, caregivers' burden and health. Regarding family intervention, there are methodological differences between studies and variability in the sample characteristics and the intervention used. Most evidence-based studies support the efficacy of adjunctive family treatment in the illness outcomes, both in youth and adult population, as well as benefits for caregivers. The results emphasize the need to involve caregivers in the therapeutic management of BD through tailored interventions based on patients' characteristics and family needs.

Nurses' Experience of Maintaining Their Therapeutic Relationship With Outpatients With Bipolar Disorder and Their Caregivers During Different Stages of a Manic Episode: A Qualitative Study.

PURPOSE: Caregivers often consult community mental health (CMH) nurses when they recognize prodromes of mania in the outpatient. The purpose of this study was to determine nurses' experiences of their therapeutic relationship and nursing interventions to outpatients and caregivers during different stages of mania. DESIGN AND METHODS: A qualitative study was conducted. Nine nurses were interviewed. FINDINGS: CMH nurses experienced dual loyalty when facing conflicting interests. They strived to stay connected to patients and caregivers with an open and nonjudgmental attitude. In euthymic episodes, nurses anticipated by developing good relationships with both and by making relapse prevention plan. PRACTICE IMPLICATIONS: Early involvement of caregivers in the treatment is recommended.