Nursing Research: Patients View

A national survey of GP and nurse attitudes and beliefs towards depression after myocardial infarction Joanne Haws, Janet Ramjeet and Richard Gray 2011 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 3215–3223 Aim— to investigate attitudes to depression after myocardial infraction Background. Depression after myocardial infarction affects almost half of all patients and has a considerable negative effect on recovery.
Despite the increased prevalence of depression in this population, it is often not recognized or treated. Results—Diagnosing depression was perceived as complex by both groups but significantly more so by nurses. We observed that training seems to have a significant effect on reported practice. Practitioners who reported that they had recent training in the management of depression were significantly more accurate in their estimate of how common depression was in this population.
Depression may be under-diagnosed in this population because primary care practitioners, especially nurses, are not aware of how common the disorder is and lack competence in diagnosis. There is merit in developing and testing a brief training intervention to ensure competence in depression screening and treatment in post-myocardial infarction patients. Relevance to clinical practice. Diagnosing depression in post-myocardial infarction patients is perceived by nurses as complex but training in the management of depression is seen as helping practice.

Support
Lack of supportive recourses can have serious implications for patient care and treatment. ……..stated that nurses did not feel supported by management and the ward environment was not appropriate for psychiatric patients.
A similar study by Happell et al (2009) discovered that nurses need the support of management and colleagues. Nurses in this study felt unsafe on the unit because of lack of facilities and institutional resources to address client needs and staff safety factors. A study by Bjongarrd et al (2007) highlights an additional problem in meeting all patients’ needs and demands by asserting many patients with severe mental illness can also be recourse-draining.
Promoting mental health care in a rural paediatric unit through participatory action research Brenda Happell,1,2 Lorna Moxham,1,2 Kerry Reid-Searl,1–3 Trudy Dwyer,1,2 Julie Kahl,4 Jodie Morris2 and Narelle Wheatland 3 Aust. J. Rural Health (2009) 17, 155–16
A study designed by Happell et al 2009, provides a different view with the aim of promoting mental health care in a rural paediatric unit. The study desgin involved a participatory action research approach proving 24 nurses with the opportunity to become actively involved. This study involved paediatric nurses however results yielded similar to studies on general nurses attitudes in relation to mental illness. This study indirectly implies that mental health is considered a specialist discipline area by many other nursing disciplines and indeed the general public.
A lack of understanding of general nurses’ role in the management of young people admitted to the paediatric unit with an acute mental illness, meant participants’confidence in caring for such patients’ was affected: I just never feel like I’m doing the right thing when Ilook after them. [FG1] Participants felt as though they were constantly seeking support and all expressed a strong desire for professional education, training and workshops.
Patients view
World health organisation 2013
People with mental disorders around the world are exposed to a wide range of human rights violations. The stigma they face means they are often ostracized from society and fail to receive the care they require—or in management.
People with mental disorders may also face discrimination on a daily basis including in the fields of education, employment and housing.
Patients view
Johan Ha°kon Bjørngaard Æ Torleif Ruud Æ Svein Friis
The impact of mental illness on patient satisfaction with the therapeutic relationship. A multilevel analysis Soc Psychiatry Psychiatr Epidemiol (2007) 42:803–809 Background The relationship between patients and their clinicians is an essential factor in psychiatric treatment. The purpose of this study was to analyze the influence of psychopathology on patient satisfaction with the therapeutic relationship. Method involved collection of data from 969 patients.
Patient’s satisfaction with therapeutic relationship was assessed with a six-item scale: sufficient time for contact/dialogue, clinicians’ ability to listen and understand, follow-up of planned interventions, respect for patients’ views/opinions, cooperation among clinicians, and patients’ influence on treatment. Mental illness was assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale. Diagnoses were established using the International Statistical Classification of Diseases and Related Health Problems—10th revision (ICD-10). Treatment outcomes were clinically assessed retrospectively by rating changes from start of treatment on seven items. Multilevel regression analysis was used for a simultaneous analysis of the contribution of patient and team variables. Conclusions
Patients’ perceptions of the therapeutic relationship may be influenced by psychopathology. Teams comprising many patients with severe mental illness may constrain the therapeutic relationship. Hence, resources and organizational measures should be carefully considered in such care units.
Because response rates in surveys of patient satisfaction with psychiatric services are usually low, results cannot be unequivocally claimed to be representative of all patients [12, 28]. Although it seems that patients with more severe mental illnessare less likely to participate in patient satisfaction surveys [12], the possible consequences of low response rates are not fully understood. The following study attempts to overcome the previous limitations of research reported in the literature by analyzing the influence of psychopathology on patient satisfaction with the therapeutic relationship.
Data was collected from 8 community mental health centres which operate operate as local psychiatric hospitals, offering outpatient, day treatment, ambulatory care and limited inpatient services, such as short-term crisis intervention units and longer-term rehabilitation units. All patients receiving treatment during the census period were asked to complete a questionnaire. Clinician-rated information was collected on all patients and could be linked to the patient questionnaire if patients had given their consent to the linkage. Of the 3,040 patients, 1,194 (39%) returned the questionnaire.
We were able to link 969 of the 1,194 to the clinical data, as some patients had not given consent to such linkage. This study showed that patient satisfaction with the therapeutic relationship was related to clinical assessment of mental illness, both due to each patient’s psychopathology as well as to the composition of mental illness severity in each team.
A study by Johan et al (2007) takes a different perspective by analysing the influence of psychopathology on patient satisfaction with the therapeutic relationship. Data was collected from 3,040 patients and only 1,194 (39%) returned the questionnaire. Patient’s satisfaction was assessed using a six-item scale and the patient’s level of mental illness was then assessed using the Health of the Nation Outcome Scales (HoNOS) and Global Assessment of Functioning (GAF) scale.
For instance, it is likely that the patients’ mood would be affected by the severity of their illness; hence, to some extent, experiences could be coloured by the mental illness itself. The results of this study indicate that patient’s degree of mental illness has an effect on their satisfaction of the therapeutic relationship. These results were to be expected as patient’s moods are likely to be affected by the severity of their illness. The results of this study however are limited because of low response rates (only 39% of mental health patients responded) (Johan et al 2007). Low response rates have long been indicated as a common problem in mental health user surveys (Ruggeri 1996).

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