Persistent and severely mentally ill clients' perceptions of their mental illness

Impact of a diagnosis of psychosis: user-led qualitative study

Aims and Method

To explore the impact of diagnosis on people who experience psychosis. Eight participants were interviewed about the impact that diagnosis had on them.

Results

The research found that the impact of diagnosis can involve both positive and negative elements. It can be a ‘means of access’ as well as a ‘cause of disempowerment’. It can help by ‘naming the problem’ and hinder by ‘labelling the person’. It is a ‘cause of social exclusion’ for all, but despite this service users can be successful in ‘achieving social inclusion’.

Clinical Implications

The findings have implications for how diagnosis is imparted by psychiatrists if they are to help to facilitate recovery and social inclusion.

Quality of life of people with mental health problems: a synthesis of qualitative research

PURPOSE

To identify the domains of quality of life important to people with mental health problems.

METHOD

A systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis.

RESULTS

We identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or 'ill-being' were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization.

CONCLUSIONS

Generic measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems.

Psychophenomenology of the postpsychotic adjustment process

A clinical phenomenological study with nine adults with schizophrenia explored the postpsychotic adjustment stage of recovery from a psychotic episode to map a psychological recovery trajectory. Participants (ages 21-37 years) were actively involved in an early psychosis outpatient treatment program. Psychophenomenological analysis of interview data resulted in 458 descriptive expressions reflecting four structural elements. Cognitive dissonance involved achieving pharmacological efficacy and cognitive efforts to "sort out" the experience. Insight was distinguished by mastery of autonomous performance of reality checks. Cognitive constancy was marked by resuming interpersonal relationships and age-appropriate activities. Ordinariness involved consistent engagement in daily activities reflective of prepsychosis functioning.

Effectiveness of a psychosocial intervention model for persons with chronic psychiatric disorders in long-term hospitalization

The article describes a psychosocial model of intervention with psychiatric patients in long-term hospitalization in a psychiatric ward in Israel and reports the findings of the evaluation conducted of its effectiveness. The model was aimed at maintaining or improving the patients' functioning in four main areas: personal hygiene, environmental maintenance, occupational competency, and social and recreational activities. For each patient, an individualized intervention program was designed and implemented by a personal case manager appointed from the ward's clinical staff. The programs involved family and ward staff as well as the patients themselves. The evaluation, based on comparison of monthly data for 4 months before and 12 months during the intervention, showed significant improvement in all but two areas of functioning: social functioning and psychiatric status. The findings, although in need of confirmation in larger, representative samples of patients in Israel and elsewhere, hold promise for effective intervention with patients whose treatment today consists largely of medication.

Being there for another with a serious mental illness

In this article I describe the unique caring and caretaking relationship between a mentally ill person and the nonprofessional caretaker in his or her life. Stressing the perspective of the caretaker, I call this relationship "being there" for the mentally ill person. I collected the data through in-depth interviews and used a descriptive phenomenological approach to unveil the general structure of the experience. Eight constituents emerged as central to the general structure of this experience: (a) accepting the changed other and grieving the loss of who the other once was; (b) taking action in challenging circumstances; (c) recognizing the ongoing, never-ending, and sometimes unpredictable nature of the experience; (d) feeling isolated; (e) having ambiguity of the heart; (f) experiencing the tension of waiting; (g) knowing the other well; and (h) caring for the other. Knowledge gained from the study findings will help health care professionals understand and support people who are in this experience from a more caring paradigm.

The stress process perspective and adaptation of people with schizophrenia--an exploratory study

BACKGROUND

Adaptation of people suffering from schizophrenia still raises numerous questions left unanswered by correlational studies and predictive models. A theoretical framework likely to bring new answers is the stress process perspective. Using the transactional model of coping, to which psychological and social variables have been added, this exploratory research studies the adaptation of 101 people with schizophrenia.

METHOD

The research design is correlational with only one crosswise measure.

RESULTS

The model predicts 60.7% of variance of adaptation and gives support that the transactional model of coping contributes to this variance. Five variables show a significant effect and account for 48% of the variance, and three interaction effects (two two-way and one three-way) add another 12.7% to the explained variance.

CONCLUSION

Results give support to the significant impact of the variables education, age and negative symptoms on adaptation. They highlight the importance of accommodation, a cognitive strategy used by people with schizophrenia to increase their adaptation. They also challenge the broadly accepted assumption of a negative influence of life events on adaptation. Finally, the interaction effects allow us to better understand the mutual effects of variables on adaptation and confirm their relevance.

"It's overwhelming... everything seems to be too much:" A theory of crisis for individuals with severe persistent mental illness

Crisis in individuals with severe persistent mental illness (SPMI) is a poorly understood phenomenon for which traditional crisis models do not apply. In this study we explored the crisis experience using in-depth interviews conducted with individuals with severe persistent mental illness from two community support programs. A grounded theory of the crisis experience was developed and the results illustrate that underlying vulnerability sets the stage for crisis occurrence which involves feeling overwhelmed and lacking control and manifests as agitation/anger/aggression, being low, feeling anxious, or euphoria. Immediate responses to crises involve getting help or managing alone and numerous factors contribute to crisis resolution and prevention.

Measuring the impact of housing on people with schizophrenia

Review of the available literature, from various countries, on housing options indicates that, for people with a mental illness, boarding houses are the least desirable type of community accommodation and that living in their own home is the most desirable type of accommodation. The present research project provides a more in-depth examination of people with schizophrenia and the impact of living in their own home compared to living in a boarding house. In this Australian study there were 3231 subjects, 3033 who were living in their own homes and 201 living in boarding house accommodation. The study used two instruments from the Mental Health Classification and Service Cost Project, specifically the Health of the Nation Outcomes Scale, which is a measure of current symptoms, and a shortened version of the Life Skills Profile, which measures global level of functioning. Results indicated that while there were no differences in the level of psychiatric symptoms experienced, people living in boarding houses had less access to social support, meaningful activities and work; they also had a significantly lower level of global functioning. These findings contradict the conventional wisdom that people with schizophrenia resort to living in boarding houses because of their level of disability and highlights an area of potential intervention for community health services.

The Knowledge Resource Base: beginning the dialogue

The Knowledge Resource Base (KRB) is a conceptual approach to the various types of knowledge used to understand and make sense of mental illness. It is an attempt to go beyond the everyday notion that real knowledge is in the hands of clinical experts and that consumers/survivors, families, and the public have little to contribute. There are four components to the KRB, each of which represents a different perspective or type of knowledge about mental illness; medical/clinical, social scientific, experiential, and customary/traditional. The purpose of this paper is to explore the medical/clinical and experiential components of the KRB by initiating a dialogue between consumers/survivors, families, and mental health professionals regarding these components. The strengths and weaknesses of each component are identified through individual interviews and a focus group.

Praxis as a mirroring process: teaching psychiatric nursing grounded in Newman's health as expanding consciousness

The purpose of this column is to describe the application of Newman's theory of health as expanding consciousness in nursing education. The authors examine the value of mirroring presence, self-reflection, appreciation of meaning and pattern, and creative approaches to student learning in their care of clients with chronic mental illness. Praxis as the basis for caring in the human health experience is discussed in this newly developed teaching-learning model.

The relationship between community psychiatric nurses and clients with severe and persistent mental illness: the client's experience

The aim of this phenomenological study was to construct an interpretation of the experience of nurse-patient relationships, in the context of community psychiatric nursing. The purpose of this paper is to focus on the experience of the relationship from the perspective of the clients. Themes of 'having someone looking out for me', 'working in collaboration', and 'being understood and gaining understanding' were identified. This thematic structure was used to understand the meaning of the relationship for the clients. Implications for practice, education, clinical supervision and mental health services are discussed.

Depression in schizophrenia: nursing care as a generalized resistance resource

Although depression can be a feature of acute psychosis and an aftermath of a psychotic episode (postpsychotic depression), data indicate that depressive syndromes in schizophrenia can be found years after the immediate postacute phase. Researchers acknowledge the clinical importance of recognizing that depressive symptoms are frequently described in patients diagnosed with schizophrenia. Using the framework of Antonovsky's (1972, 1987, 1992) Sense of Coherence as a guide, this article explores what nurses can do to facilitate development of generalized resistance resources (GRRs) in the physical, psychological, and emotional armamentarium of those diagnosed with schizophrenia, mood disorder not otherwise specified (NOS).

Defining care in the culture of the chronically mentally ill living in the community

The ethnonursing method was used to discover care meanings, expressions, and experiences of the chronically mentally ill to guide nurses in promoting the health and well-being of these people. Fifteen key and 24 general informants were interviewed. Six major themes were abstracted: (a) care as listening and giving presence is meaningful to the chronically mentally ill; (b) they desire to give care to others; (c) they are a subculture; (d) mental illness carries a public stigma in the dominant culture; (e) flexible and growth-promoting care practices are desired; and (f) the chronically mentally ill desire normalcy but fear rejection by the dominant culture.

Living with serious mental illness: the desire for normalcy

This article describes the desire for normalcy as experienced by 6 men and 13 women with serious mental illness based on secondary analysis of data from two previous qualitative studies. Original data were collected by structured and semi-structured interviews, and thematic analysis was done. Major categories of desire for normalcy are having normal things and experiences; doing meaningful activities; and being well, safe, free, and independent. Self-care actions to promote and maintain normalcy are identified, and finding are discussed in relation to Orem's self-care deficit theory of nursing. Implications for nursing theory, research, and practice are addressed.

Being mentally ill: a phenomenological inquiry

There have been few studies that have attempted to understand the world of one who is mentally ill. This interpretive phenomenological study, which began as a study of the meaning of being restrained, became a glimpse into mental illness. For this study, 10 psychiatric patients were questioned in unstructured interviews. The taped interviews were transcribed, and the resulting texts were analyzed with use of a modification of an eight-stage process. Heideggerian hermeneutical phenomenology provided the philosophical framework for this study. Two major themes--struggling and "why me?"--revealed what it is like for the participants to live with a serious mental illness. These participants struggled with the staff on the unit, with being restrained, and with the symptoms of their illness. As part of their struggling, they asked, "Why me?"--a question that could be interpreted existentially as, why are things the way they are and not some other way? Finally, this study underscores how important it is for the nurse caring for a psychiatric patient to enter into, and try to understand, the world of patients with mental illnesses.

Patients' views of quality of life: transforming the knowledge base of nursing

Nurses in advanced practice roles are leaders of the transformative process that will further define the discipline of nursing as a human science of lived experience. Essential to the transformation is a change in nursing's knowledge base, a change that defines practice and research as participative, open, and quality enhancing. To demonstrate the transformation of knowledge in practice, the authors present findings from a qualitative research study guided by the nursing theory called human becoming. The purpose of the study was to enhance understanding of quality of life for patients receiving acute psychiatric care. A descriptive exploratory design was used to guide data gathering and analysis of 24 people. Findings are presented in themes that represent quality-of-life issues, including feelings of loss and shifting value priorities, the complex nature of relationships that ease and upset, and the hopes that fuel the intense struggle to go on living. Directions for practice and research are suggested.

Clients with schizophrenia and their caregivers' perceptions of frequent psychiatric rehospitalizations

The purpose of this phenomenological study was to achieve an understanding of the lived experience of the event of rehospitalization as seen by the schizophrenic patient and his or her designated caregiver. Five schizophrenic clients who met criteria and their designated caregivers were located using purposeful intensity sampling. A standardized open-ended interview was conducted with each informant using a dialogical approach. After redundancy was reached, data were analyzed using the constant comparative method. Five themes reflecting the meaning of recidivism evolved from the data. These included rehospitalization as an event that: provided a safe place, provided stabilization of medication, produced a renewal of hope, reinforced frustration with the mental health care system, and produced decreased individual control. Findings can be used to develop a more comprehensive model of care for intervention with patients and caregivers.