The psychological well-being of renal peer support volunteers

Assessing the effect of dialogue on altruism toward future generations: A preliminary study

Introduction

Despite the abundance of evidence on climate change and its consequences on future generations, people, in general, are still reluctant to change their actions and behaviors toward the environment that would particularly benefit posterity. In this study, we took a preliminary step in a new research direction to explore humans' altruistic behavior toward future generations of people and whether it can be affected by dialogue.

Methods

We used an android robot called Telenoid as a representative of future generations by explaining that the robot is controlled by an Artificial Intelligence (AI) living in a simulation of our world in the future. To measure people's altruistic behavior toward it, we asked the participants to play a round of the Dictator Game with the Telenoid before having an interactive conversation with the Telenoid and then playing another round.

Results

On average, participants gave more money to the Telenoid in the second round (after having an interactive conversation). The average amount of money increased from 20% in the first to about 30% in the second round.

Discussion

The results indicate that the conversation with the robot might have been responsible for the change in altruistic behavior toward the Telenoid. Contrary to our expectations, the personality of the participants did not appear to have an influence on their change of behavior, but other factors might have contributed. We finally discuss the influence of other possible factors such as empathy and the appearance of the robot. However, the preliminary nature of this study should deter us from making any definitive conclusions, but the results are promising for establishing the ground for future experiments.

Peer Mentoring as an Avenue to Explore in Kidney Transplantation: Kidney Transplant Recipients' Perspectives on Peer Mentoring

Kidney transplant recipients (KTRs) face numerous challenges following transplantation. Given that healthcare professionals do not necessarily have first-hand experience living with or waiting for a transplant, it may be hard for them to communicate with and help patients when it comes to transplant-related issues. KTRs have experiential knowledge, which could enable them to help other patients going through similar situations. Peer mentoring involves pairing mentees with individuals who have had similar experiences, to provide training, information, and emotional support. The aim of this study was to gather KTRs’ perspectives on a potential peer mentoring program.

Depressive symptoms and unmitigated communion in support providers

In this research, we argue and demonstrate that the association between enacted (un)supportive behaviour and depressive symptoms is a function of the providers' levels of unmitigated communion (UC). UC is characterized by overinvolvement in others' problems, self‐neglect and externalized self‐evaluation. These characteristics appear to predispose individuals high in UC to experience depressive symptoms. As anticipated, we show that enacted supportive behaviour was negatively associated with depressive symptoms (Study 1 and 2), and enacted unsupportive behaviour was positively associated with depressive symptoms (Study 2), but only among individuals low in UC. Our findings are consistent with the idea that for high UC individuals, enacting supportive behaviour, or not enacting unsupportive behaviour, is insufficient to reduce their high levels of depressive symptoms. Copyright © 2009 John Wiley & Sons, Ltd.

Eficacia de la creación de un programa de Escuela de pacientes en la detección de necesidades en pacientes con Poliquistosis Renal Autosómica Dominante

Introducción: La Poliquistosis Renal Autosómica Dominante es una enfermedad renal crónica responsable del 10% de los casos de insuficiencia renal terminal. La participación y los grupos de apoyo entre iguales son herramientas que mejoran el bienestar, evitando complicaciones y retrasando el avance de la enfermedad. Objetivos: Detectar necesidades informativas, así como recursos de apoyo, en este grupo de pacientes mediante la puesta en marcha de una Escuela de Pacientes con poliquistosis renal autosómica dominante. Material y Método: Se utilizó un diseño mixto (cuantitativo y cualitativo). El estudio se desarrolló mediante cuatro fases: 1) Grupo focal: pacientes con poliquistosis renal y sus cuidadores; 2) Selección de los pacientes expertos; 3) Elaboración de los contenidos del programa de la Escuela de pacientes con poliquitstosis renal autosómica dominante; 4) Pilotaje del programa. Resultados: Se detectaron necesidades de información referentes al tratamiento oral y al afrontamiento de la poliquistosis renal que no están cubiertas por los equipos de nefrología. Conclusiones: La Escuela de Pacientes ha demostrado ser una herramienta útil para detectar necesidades y recursos en pacientes con poliquistosis renal autosómica dominante que han de enfrentarse a una enfermedad crónica donde se requiere la participación del paciente para garantizar la adhesión al tratamiento.

Peer Support Workers in Health: A Qualitative Metasynthesis of Their Experiences

OBJECTIVE

Peer support models, where an individual has a specific illness or lifestyle experience and supports others experiencing similar challenges, have frequently been used in different fields of healthcare to successfully engage hard-to-reach groups. Despite recognition of their value, the impact of these roles on the peer has not been systematically assessed. By synthesising the qualitative literature we sought to review such an impact, providing a foundation for designing future clinical peer models.

METHODS

Systematic review and qualitative metasynthesis of studies found in Medline, CINAHL or Scopus documenting peer worker experiences.

RESULTS

1,528 papers were found, with 34 meeting the criteria of this study. Findings were synthesised to reveal core constructs of reframing identity through reciprocal relations and the therapeutic use of self, enhancing responsibility.

CONCLUSIONS

The ability of the Peer Support Worker to actively engage with other marginalised or excluded individuals based on their unique insight into their own experience supports a therapeutic model of care based on appropriately sharing their story. Our findings have key implications for maximising the effectiveness of Peer Support Workers and in contributing their perspective to the development of a therapeutic model of care.

Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL

BACKGROUND

The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as 'buddies') organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16-25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as 'participants').

METHODS

A mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n = 62), and observations during two camp weeks.

RESULTS

Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees' sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.

CONCLUSIONS

Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult care, they could take on a role in selecting buddies.

The psychological assessment of candidates for reconstructive hand transplantation

Standardized psychological assessment of candidates for reconstructive hand transplantation (RHT) is a new approach in transplantation medicine. Currently, international guidelines and standardized criteria for the evaluation are not established. Patients suffering from the loss of a hand or an upper extremity have to cope with multiple challenges. For a selected group of patients, RHT represents an option for restoring natural function and for regaining daily living independence. The identification of at-risk patients and those requiring ongoing counseling due to poor coping or limited psychological resources are the primary focus of the psychological assessment. We have developed the 'Innsbruck Psychological Screening Program for Reconstructive Transplantation (iRT-PSP)' which utilizes a semi-structured interview and standardized psychological screening procedures and continuous follow-up ratings. Between January 2011 and October 2011, four candidates were evaluated using the iRT-PSP. Psychological impairments including social withdrawal, embarrassment, reduced self-esteem, and a depressive coping style were identified and poor quality of life was reported. The motivation for transplantation was diverse, depending on many factors such as bi- or unilateral impairment, native or accidental loss of hand, and social integration.

"Positive Examples": a bottom-up approach to identifying best practices in HIV care and treatment based on the experiences of peer educators

Literature describing the roles and activities of peers working in HIV care is limited. Evaluations of the impact of peer-based behavior-change interventions reveal mixed results, due in part to varied program aims, structure, evaluation mechanisms, and training. Peers themselves are important resources to address these concerns and lay the groundwork for developing improved programs and evaluation strategies. This qualitative article describes peer support in HIV care and treatment from the perspective of 23 HIV-positive peers across the United States. Peers reported that peer characteristics (HIV-status, common experiences, and self-care) enable them to engage clients. Peers also required flexibility to respond to client needs, and their activities spanned four types of social support: informational, emotional, instrumental, and affiliational. We recommend peer programs and evaluations accommodate the broad scope of peer work by acknowledging the need for flexibility and activities that are not always directly related to clients' HIV care and treatment.

Embodied work: insider perspectives on the work of HIV/AIDS peer counselors

Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive women's lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value of their work, which, like much of women's work within the context of family and community, lacks public visibility and acknowledgment. We discuss implications for the training and support of peer-based interventions for HIV and other women's health issues across diverse contexts and settings.

Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes

Background

Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting.

Methods

The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention.

The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention.

Results

The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4.Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention.

Conclusion

The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care.

Trial registration

Current Controlled Trials ISRCTN42541690

The peer-professional interface in a community-based, breast feeding peer-support project

OBJECTIVE

to explore key elements of the peer-professional interface within one breast feeding peer-support project.

DESIGN

a descriptive, qualitative study design. Data were generated through focus-group discussions with volunteer peer supporters and health professionals.

SETTING

the Breastfriends scheme was a community-based, peer-support project located in Doncaster, a town in the North of England.

PARTICIPANTS

all of the volunteer peer supporters who were involved in the scheme at the time of data collection (n=7). In addition, a convenience sample of health professionals (community midwives and health visitors [n=9]) was also generated.

ANALYSIS

thematic analysis of the data was undertaken. Two key themes that have relevance to understanding the peer-professional interface were derived: benefits of working together, and constraints on enabling working relationships.

FINDINGS

benefits associated with participating in the breast feeding peer-support scheme were highlighted by volunteers and health professionals. Volunteers experienced enhanced social support and increased self-esteem and personal development. Health professionals benefited from being able to 'spread the load' of breast feeding support. Some health professionals were also able to learn from volunteers' specialist experiential and cultural knowledge. Health professionals were concerned about volunteers transgressing (poorly defined) boundaries. Both volunteers and health professionals described gate-keeping activities and surveillance behaviours practised by health professionals in an effort to control aspects of volunteers' access to, and work with, breast feeding women.

DISCUSSION

as a cohort of peer supporters develops, members may derive benefits from their participation that extend beyond those predicted and planned for in the project. They may also exert a proactive influence upon the evolution of the peer-support project and upon the relationships between volunteers and health professionals. However, midwives and health professionals may also seek to exert influence over the work of peer supporters, preferring the volunteers to work for, rather than with, them as health professionals. It is at the peer-professional interface that any disjuncture between the project ideal and the reality of the group may be most evident and most problematic.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

in order to reduce tension at the peer-professional interface, and optimise relationships between volunteers and health professionals, an ongoing process of development involving volunteers and health professionals is essential. Such a process would need to proactively identify and diffuse professionals' concerns while addressing both volunteers' vulnerabilities and their potential for semi-autonomous development within and beyond the context of the peer-support scheme.

Peer support. An under-recognized resource in cardiac recovery

BACKGROUND

Cardiovascular disease remains the leading cause of mortality and premature death in western societies. Thus, rates of interventions such as coronary artery bypass surgery are continuing to grow. Health care reform and initiatives to reduce health care expenditures have resulted in early patient discharge from hospital following cardiac surgery. With subsequent cutbacks in nursing support and community-based care, patients are leaving hospital less prepared and supported to deal with the changes that occur during the first weeks of recovery.

AIMS

To examine the theoretical assumptions that support the contention that peer support is an under-utilized resource for patients who are recovering from cardiac surgery and the challenges to evaluating peer support interventions.

METHODS

A review of current literature, which focuses on cardiac surgery recovery, transitions, social support, and peer support interventions.

RESULTS

Peer support (lay assistance from individuals who possess experiential knowledge and similar characteristics), a form of social support, is a viable and potentially sustainable mechanism to put in place during transitional life events such as recovery from cardiac surgery.

CONCLUSIONS

Further investigation is needed of peer support interventions for cardiac surgery patients. Specifically, investigations of the influence of peer support interventions on recovery and health outcomes are necessary in this patient population. Yet, challenges exist to undertaking well-designed investigations of social interventions such as peer support.

Partnerships in Mending Hearts

As a growing number of older adults recover from cardiac events, volunteer programs have emerged to provide low-cost community support to vulnerable elders. Although an increasing number of studies have described the beneficial relationships between patients and volunteers, little is known about the unique partnership between the advanced practice nurse (APN) and the volunteer peer. The purpose of this article was to explore the interaction between the APN and the peer advisor who provide support for unpartnered elders after myocardial infarction or coronary artery bypass grafting. As part of a larger research study, "Improving Health Outcomes for Unpartnered Cardiac Elders" (R01-NR05205), interactions with peers were recorded by APNs. Essential themes related to working with 20 peer advisors emerged from 30 logs. Findings suggest that establishing the peer support role, acknowledging abilities, and overcoming difficulties are important steps in the relationship. A partnership between healthcare professionals and peer advisors enhances social support for vulnerable elders recovering from myocardial infarction and coronary artery bypass grafting.

The HRQoL of renal transplant patients

BACKGROUND

After undergoing kidney transplant surgery, patients face many new challenges. For example, they face new pathologies associated with the complex medical regimens that they will need to follow rigorously for the rest of their lives. They live with the uncertainty and fear of organ rejection. They will also need to acquire new skills to take care of themselves, such as recognizing the signs and symptoms of impending infection and rejection. This suggests that once a transplant has been performed and the patient has been discharged with a functioning graft, the patient must continue to deal with a life of chronic illness.

AIM

The aim of this study was to explore health-related quality of life of Chinese kidney transplant patients in Hong Kong.

METHODS

Non-structured interviews were conducted. The transcripts were analysed by qualitative content analysis. Codes were used to identify a passage of text that the researcher interprets as having a particular meaning. Data analysis is an iterative process. The codes emerging from each new interview were analysed together with the codes which had previously emerged. Across the dataset, codes were compared for similarities and differences, both within and across interviews. Codes of common property were clustered into categories. The transcripts were re-read and checked against the categories until there was no more to be gleaned, and the titles of the categories reflected the totality of that experience. Interviews were conducted until unique categories were no longer identified. There were 31 participants.

RESULTS

The participants are complying with medication regimens and nursing recommendations. Although new symptoms related to the medication regime surfaced, participants commented that they improved markedly in physical and social functioning, and have a better quality of life as a whole. Participants expressed their needs regarding information on the side effects of medications, proper exercise and diet.

CONCLUSIONS

To optimize post-transplant quality of life, a follow-up rehabilitation programme is recommended.

RELEVANCE TO CLINICAL PRACTICE

Rich and meaningful insights about the perceptions and experiences of renal patients after transplantion can be obtained in this study. Having known the real needs of patients, nurses can develop strategies to help patients to cope with the demands of life with a renal graft, from the early days of convalescence to re-integration into work, family responsibilities and life beyond.