Living on a razor's edge: Experiences of mothers caring for a son on synthetic cannabinoids in Malta

Various studies have explored collectively the experiences of carers of individuals using illicit substances. Yet such experiences vary by gender, by relationship status to the substance user, by type of drug taken and whether the substance user lives within the same household. A hermeneutic phenomenological design was undertaken with five mothers of sons on synthetic cannabinoids (SC). These sons were receiving community mental health care following admission to hospital for episodes of drug-induced psychosis. Interview data were collected between August and October 2019. The transcribed texts were analysed using interpretative phenomenological analysis and interpreted using the Common-sense model. The superordinate theme 'Living on a Razor's edge' was extracted and consisted of two themes: 'A living Calvary' and 'Fighting a Lone battle'. The findings highlight the intense psycho-emotional suffering of the mothers, who experienced anxiety and fear relating to their welfare and that of the family; helplessness at not being able to communicate their concerns to their son and shame triggered by the judgmental attitude of others. Carers primarily associated the effects of SC such as psychotic episodes, to their sons being vulnerable individuals with mental health challenges rather than due to their drug habit. The mothers expressed feeling isolated as they could not turn to any family member or friends for support. The highly volatile and impulsive nature of their son further introduced a wedge between the female carer and her spouse, children, extended family and friends. Caring for a son on SC has a significant psycho-emotional and social impact on the mothers as informal carers. Hence, there is a need for a person-centred care approach to be provided, in which the shared understandings of the mothers narratives are explored and where their needs and concerns are integrated and addressed within a care plan.

Navigating the Storm to Recovery through the Pictorial Representations of Persons in the Recovery Phase from Unipolar Depression

Depression is a highly complex mental illness that presents challenges, such as difficulties for persons with depression to communicate their experiences. This is compounded further by a paucity of in-depth and pictorial accounts on their experiences of the recovery process. The combination of pictorial representations and interviews with persons who are recovering from depression, may assist them in communicating these lived experiences. Five participants recovering from unipolar depression and who were in the late stages of recovery were recruited through purposive sampling. Data were collected through the conduction of art sessions, where participants pictorially represented their experience of living with depression and their road to recovery. Semi-structured interviews were then used to explore their artwork. The transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes emerged from participants' interviews, namely: 'A New Me in Me' that incorporating changes in their identity, physical, emotional, and social experiences, and 'Life as an amalgamation of colour' describing their search for meaning and the importance of spirituality, hope, gaining control and positivity in the recovery process. The use of pictorial representations combined with interviews can add depth to participant narratives, that serve to enhance the therapeutic alliance between the patient-professional dyad.

Psychiatric hospital nurses' attitudes towards trauma-informed care

WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

Caring for a parent with pulmonary fibrosis in Malta: The lived experiences of daughters in mid-adulthood

Idiopathic pulmonary fibrosis is a progressive fibrotic lung disease that is on the rise globally. The disease is associated with significant morbidity and hence poses significant challenges for their informal carers, particularly daughters in mid-adulthood, who struggle with their own personal demands and that of their ill parents. Yet there is a dearth of literature on the experiences of these specific carers. Hence, the purpose of this study is to explore the lived experiences of daughters caring for a parent with pulmonary fibrosis within a community setting. This was explored using a phenomenological qualitative framework that was conducted between January and April 2017. Semi-structured audio-recorded interviews were conducted with six adult daughters who provided care to a parent having pulmonary fibrosis. Purposive sampling was used to recruit study participants. Transcribed data were analysed using Interpretative Phenomenological Analysis. Three main themes were extracted which communicate the essence of the daughters' lived experiences: "Walking on tiptoes", "Flooded by emotions" and "Shifts in family dynamics." Participants described experiencing the toll of being constantly vigilant for symptoms. They also expressed a range of emotions that included guilt, helplessness and worry related to their care experience. However, these emotional struggles were suppressed in order to present an external facade of strength and control. A shift in roles was also described where the daughters became the informal carers/support for both their ill and well parent, albeit in different ways. Caring for a person with pulmonary fibrosis is an emotional and life changing experience and hence, there is the need for individualised interventions that target the unique perceptions of these informal carers.

Service Users' Perception of the Therapeutic Milieu in a Mental Health Rehabilitation Unit

Although the concept of the therapeutic milieu has been given prominence, the perceptions of care receivers in this regard are sparse. This study aimed to explore service users' perceptions of the therapeutic milieu in a mental health rehabilitation unit. The method used was document analysis of annual reports generated by the unit through data collection from the care receivers. Four themes were identified, namely, the 'physical environment', the 'structure of the therapeutic programme', 'relationships with the professionals' and the 'experience of living as a community'. The study contributed to previous research through meaningful ramifications for research, practice and education.

Pulmonary rehabilitation for chronic obstructive pulmonary disease: effects of a high versus low intensity programme

Background/Aims

Pulmonary rehabilitation is known to facilitate improvements in chronic obstructive pulmonary disease symptoms, exercise tolerance and quality of life. Despite this, there is no consensus on the ideal programme intensity. This article aims to explore and compare the benefits of a high intensity and low intensity pulmonary rehabilitation programme.

Methods

A total of 30 patients with a diagnosis of chronic obstructive pulmonary disease were randomly and blindly allocated to either a high intensity or low intensity 12-week pulmonary rehabilitation programme.

Results

Significant improvements in functional and health-related quality of life measures were obtained in both groups. Most of the significant changes for the high intensity group were achieved by week 8. The low intensity group required a further 4 weeks of rehabilitation in order to reach a significant difference.

Conclusions

Results show that both low and high intensity pulmonary rehabilitation programmes were beneficial. However, the high intensity programme was more efficient in achieving these improvements than the low intensity group.

Pulmonary Rehabilitation in patients with Interstitial Lung Disease: The effects of a 12-week programme

BACKGROUND

The inclusion of Pulmonary Rehabilitation as part of the management of Interstitial Lung Disease, although being highly recommended in most recent guidelines, still has limited studies exploring the outcomes from such an intervention. The present study aims to contribute to the available literature by investigating the effects of a high intensity, 12 week PR programme on functional and quality of life measures in patients with a diagnosis of Interstitial Lung Disease.

METHOD

ology: This paper reports outcomes of an observational, prospective, quasi experimental type of study. A total of 120 participants were recruited: 60 patients formed part of the active group, and another 60 patients were enrolled in an inactive group. Each participant was classified according to the modified Medical Research Council dyspnoea scale and placed in one of 5 categories (0-4) according to self-perceived breathlessness during daily activities. The following outcomes were measured: Lung function tests including plethysmography and diffusion capacity of carbon monoxide (D_LCO), functional tests (6-min walking distance test, Dyspnoea Borg Scale) and health status measures (St George's Respiratory Questionnaire and Hospital Anxiety and Depression Score).

RESULTS

A 12-week PR programme for patients with Interstitial Lung Disease, led to significant improvements in the active group of patients in the 6 min walking distance test, the modified Borg Scale, mMRC scores and in the health status measures. Lung function measures did not show any significant improvement following this intervention.

CONCLUSION

This 12week Pulmonary Rehabilitation programme resulted in improvements in functional aspects for patients with Interstitial Lung Disease. Further studies are recommended as Pulmonary Rehabilitation for Interstitial Lung Disease may have an impact at both an individual level and at global organisational/financial levels.

Illness perceptions, depression and anxiety in informal carers of persons with depression: a cross-sectional survey

Purpose

To examine the illness perceptions of informal carers of persons with depression, using the theoretical framework of Leventhal’s Common-Sense Model (CSM) and to determine whether these illness perceptions are predictors of anxiety and depression, as measures of psychological well-being.

Methods

A cross-sectional survey was conducted with 94 Maltese individuals caring for a person with depression within a community setting. The informal carers completed the modified Illness Perception Questionnaire (IPQS-Relatives version) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, Spearman’s rank order correlations and ANCOVA regression models, to identify predictors of anxiety and depression respectively in the informal carers.

Results

The informal carers perceived depression as a cyclical condition, having negative consequences on both the patient and on themselves. Participants perceived the causes of depression to be mainly psychosocial in nature and generally viewed the treatment as effective. Caring for a person with depression was perceived as having a considerable negative emotional impact on them. Years of caring was identified as a predictor of anxiety accounting for 20.4% of the variance, and timeline chronicity beliefs, consequences (relative) and illness coherence were identified as predictors of depression, accounting for 56.8% of the variance.

Conclusion

Illness cognitions are significant predictors of depression, thereby suggesting that cognition-based interventions may be effective in targeting depression in these informal carers. Thus, health professionals should explore the carers’ personal understanding of the disease, their timeline beliefs and the perceived consequences of providing care, as they relate to their psychological well-being.

Existing But Not Living: Experiences of Long-Term Caregivers of Individuals With Unipolar Depression

The shift in care from long-term hospitalization of individuals with mental illness to the community places a greater onus of responsibility on informal caregivers. The purpose of the current study was to explore the lived experiences of long-term caregivers of individuals with unipolar depression. A qualitative phenomenological methodology was used and two sets of semi-structured interviews were conducted with nine informal caregivers. Data were transcribed following Giorgi's phenomenological method. The following three themes were identified: Flooded by Emotions, Personal Growth and Satisfaction, and Psychosocial Effects and Challenges. Caregivers described adapting by adjusting their behavior to avoid conflict with care recipients. These adjustments had a detrimental effect on their well-being, where they described that they were "existing but not living." These findings highlight the need for ongoing support, which should be tailored to the unique needs and concerns of individuals who are providing long-term care to individuals with depression. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 16-21.].

Health status of COPD patients undergoing pulmonary rehabilitation: A comparative responsiveness of the CAT and SGRQ

The St. George’s Respiratory Questionnaire (SGRQ) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) are the measures used to assess health status. This study aims to examine the responsiveness of these tools by severity of dyspnoea category in patients with COPD. Forty-nine COPD patients who underwent a 12-week pulmonary rehabilitation (PR) programme were assessed at baseline, 12 weeks and at 28-week follow-up. Patients were categorized into two groups by severity of dyspnoea category (i.e. mild to moderate (modified Medical Research Council (mMRC) 1–2) and severe to very severe (mMRC 3–4)) using the mMRC dyspnoea scale. Effect size (ES) was computed as estimates of responsiveness. The SGRQ demonstrated greater responsiveness by total sample (SGRQ, ES = 0.87; CAT, ES = 0.75) and for the mMRC 3–4 category (SGRQ, ES = 0.91; CAT, ES = 0.76) on completion of PR. At 28-week follow-up, overall comparable responsiveness of the CAT and SGRQ was identified by total sample (SGRQ, ES = 0.75; CAT, ES = 0.74) and by severity of dyspnoea category. The symptom, impact and activity domains of the SGRQ showed good responsiveness, with greater ESs obtained overall for the mMRC 3–4 category. On completion of PR, the SGRQ demonstrates a greater responsiveness with COPD patients, especially in relation to the mMRC 3–4 category, while both the CAT and SGRQ show comparable responsiveness on follow-up.

Intimate partner violence: psychological and verbal abuse during pregnancy

AIMS AND OBJECTIVES

To examine the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse, as well as to determine which of these variables are predictors of psychological and verbal intimate partner abuse during pregnancy.

BACKGROUND

Intimate partner violence is a significant health issue, with severe implications to both mother and foetus. However, much of the research to date focuses on the outcomes of physical abuse. This article addresses the dearth in the literature by examining the association between sociodemographic, pregnancy-related variables and psychological and verbal intimate partner abuse during pregnancy.

DESIGN

A survey research design was used.

METHOD

Three hundred postnatal women were recruited by convenience, nonproportional quota sampling technique. The WHO Violence Against Women Instrument was self-administered by participants. The association between categorical variables was assessed using Pearson's chi-square test, the strength of association using Cramer's V and the phi coefficient, and the identification of predictor variables for psychological and verbal abuse using logistic regression analysis.

RESULTS

Four predictors were identified for psychological abuse, namely low education level in women, an unplanned pregnancy, experiencing two or more pregnancy-related health problems and living with an unemployed partner. However, unemployment in women, an unplanned pregnancy, fear of partner and a low education level of partner were identified as the predictors of verbal abuse.

CONCLUSION

This study identified a number of variables that strongly predict psychological and verbal intimate partner abuse during pregnancy; however, it extends the available literature by identifying a low standard of education in males, unemployment and fear of the intimate partner as the significant predictors of psychological and verbal intimate partner abuse.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should be aware of the predictors predisposing pregnant women to abuse. This would enable the identification of pregnant women who are susceptible to psychological and verbal intimate partner abuse, thus enabling the provision of adequate support. There is also a need to introduce routine screening for psychological and verbal intimate partner abuse during the antenatal period, following extensive training to all professionals concerned.

The lived experience of adults with ulcerative colitis

AIMS AND OBJECTIVES

The purpose of this study was to explore the experiences of adults living with ulcerative colitis.

BACKGROUND

Research to date has focused on the impact of inflammatory bowel disease, by analysing the responses of persons with ulcerative colitis and Crohn's disease collectively. This article addresses the dearth in literature by exploring the experiences of adults living with ulcerative colitis.

DESIGN

An exploratory qualitative phenomenological design was used.

METHOD

Semi-structured interviews were conducted with a purposive sample of 10 adults with ulcerative colitis. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three super-ordinate themes emerged from the analysis: 'living with physical discomfort', 'emotional turmoil in living the experience' and 'social interactions'.

CONCLUSION

The participants described a fundamental change in their lifestyle, as a result of physical discomfort and emotional turmoil. Misconceptions held regarding the causes of their disease, further compounded their negative emotional experience.

RELEVANCE TO CLINICAL PRACTICE

It is of importance that health care professionals understand and explore the unique perspectives of individuals with ulcerative colitis. These perspectives relate to both physical and psychosocial issues. The needs and concerns of persons with ulcerative colitis can then guide the formulation and development of an individualised care plan.