1
|
Sakellari E, Berglund M, Lagiou A, Sotto-Mayor De Carvalho Pinto ML, Ferreira Dos Santos MA, Lahti M, Murto T. Perceptions and educational needs of social and healthcare professionals in the prevention of domestic violence - A focus group study. Sex Reprod Healthc 2024; 40:100956. [PMID: 38432162 DOI: 10.1016/j.srhc.2024.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To explore and describe social and healthcare professionals' perceptions and educational needs in relation to domestic violence and its prevention. METHODS A qualitative research was conducted in three European countries. Two multidisciplinary focus group interviews were conducted (in each country) among professionals and higher education teachers in the field of social and health care. Total number of participants were 32 (Finland n=12, Greece n=12, Portugal n=8). The transcribed data were analyzed by thematic analysis. RESULTS Participants' perceptions of domestic violence and its prevention included: multidimensional phenomenon, consequences, and addressing concern. Domestic violence was seen as a multidimensional phenomenon, which has various consequences for several aspects of life. Professionals have difficulties addressing their concern due to lack of knowledge and tools. Solutions to prevent domestic violence that the participants shared were: education, intervention, and strategies. Education was seen as the key aspect for the prevention of domestic violence. Also, professionals' communication and situation management skills, as well as national and international strategies, were seen as valuable solutions. Educational needs for prevention of domestic violence were expressed based on content, methods, and practices, such as services system and legislation. CONCLUSION The findings of the current study highlight the social- and healthcare professionals' need for education about domestic violence. It is essential that these professionals receive appropriate training to effectively identify and address domestic violence. The current study provides useful information for the development of relevant training/education for this group of professionals.
Collapse
Affiliation(s)
- Evanthia Sakellari
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | - Mari Berglund
- Faculty of Health and Wellbeing, Turku University of Applied Sciences, Finland
| | - Areti Lagiou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | | | | | - Mari Lahti
- Faculty of Health and Wellbeing, Turku University of Applied Sciences, Finland
| | - Tiina Murto
- Faculty of Health and Wellbeing, Turku University of Applied Sciences, Finland.
| |
Collapse
|
2
|
Kelly P, Saab MM, Hurley EJ, Heffernan S, Goodwin J, Mulud ZA, O Malley M, O Mahony J, Curtin M, Groen G, Ivanova S, Jörns-Presentati A, Korhonen J, Kostadinov K, Lahti M, Lalova V, Petrova G, O Donovan A. Trauma Informed Interventions to Reduce Seclusion, Restraint and Restrictive Practices Amongst Staff Caring for Children and Adolescents with Challenging Behaviours: A Systematic Review. J Child Adolesc Trauma 2023; 16:629-647. [PMID: 37593061 PMCID: PMC10427579 DOI: 10.1007/s40653-023-00524-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 08/19/2023]
Abstract
Engaging with children and adolescents in mental health settings who are exhibiting behaviours that challenge can often result in the use of seclusion, restraint and coercive practices. It is recognised that more therapeutic ways to engage this population are needed, adopting trauma informed interventions may provide a solution. The aim of this systematic review is to synthesize the evidence in relation to the effect of trauma-informed interventions on coercive practices in child and adolescent residential settings. The review is guided by elements of the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Results were synthesized and reported narratively. Nine studies met the eligibility criteria for this review. There was a lack of homogeneity amongst the studies. The trauma-informed interventions used were typically multi-faceted, underpinned by a variety of approaches and sought to bring about changes to clinical practice. Most studies (n = 8) reported significant reductions in the use of restrictive practices following the implementation of a trauma informed approach. The use of a trauma-informed approach, underpinned by an organisational change or implementation strategy, have the potential to reduce coercive practices with children and adolescents. However, the included interventions were insufficiently described to draw strong conclusions.
Collapse
Affiliation(s)
- Peter Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mohamad M. Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Emma J. Hurley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sinéad Heffernan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Zamzaliza A. Mulud
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Centre for Nursing Studies, Universiti Teknologi MARA Selangor, Puncak Alam, Selangor, Malaysia
| | - Maria O Malley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - James O Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Margaret Curtin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Gunter Groen
- Sciences Hamburg Department of Social Work, University of Applied, Hamburg, Germany
| | - Svetla Ivanova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Joonas Korhonen
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland
| | - Kostadin Kostadinov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Mari Lahti
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland
| | - Valentina Lalova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Gergana Petrova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Aine O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Putkuri T, Lahti M, Laaksonen C, Sarvasmaa AS, Huttunen R, Axelin A. Mental health services in the school environment-Future visions using a phenomenographic approach. J Clin Nurs 2023; 32:2742-2756. [PMID: 35599343 DOI: 10.1111/jocn.16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state. BACKGROUND The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment. DESIGN The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents. METHOD The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist. RESULT Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level. CONCLUSION The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems. RELEVANCE TO CLINICAL PRACTICE This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.
Collapse
Affiliation(s)
- Tiina Putkuri
- Department of Nursing Science, University of Turku, Turku, Finland
- Laurea University of Applied Science, Vantaa, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University of Applied Science, Turku, Finland
| | | | - Anna S Sarvasmaa
- Finnish Student Health Service, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Rauno Huttunen
- Department of Education, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Berg J, Lipponen E, Sailas E, Soininen P, Varpula J, Välimäki M, Lahti M. Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study. J Psychiatr Ment Health Nurs 2023. [PMID: 36718606 DOI: 10.1111/jpm.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.
Collapse
Affiliation(s)
- Johanna Berg
- Turku University of Applied Sciences, Turku, Finland
| | | | - Eila Sailas
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland
| | - Päivi Soininen
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya Nursing School, Central South University, Changsha, China
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
5
|
Korhonen J, Axelin A, Stein DJ, Seedat S, Mwape L, Jansen R, Groen G, Grobler G, Jörns-Presentati A, Katajisto J, Lahti M. Mental health literacy among primary healthcare workers in South Africa and Zambia. Brain Behav 2022; 12:e2807. [PMID: 36326480 PMCID: PMC9759138 DOI: 10.1002/brb3.2807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. METHODS The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. RESULTS Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. CONCLUSION The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.
Collapse
Affiliation(s)
- Joonas Korhonen
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lonia Mwape
- Levy Mwanawasa Medical University, School of Nursing and Midwifery Sciences, Lusaka, Zambia
| | - Ronelle Jansen
- School of Nursing, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | - Gunter Groen
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Gerhard Grobler
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Astrid Jörns-Presentati
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Lahti
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | -
- Health and Well-being, Turku University of Applied Science, Turku, Finland
| |
Collapse
|
6
|
Groen G, Jörns-Presentati A, Dessauvagie A, Seedat S, van den Heuvel LL, Suliman S, Grobler G, Jansen R, Mwape L, Mukwato P, Chapima F, Korhonen J, Stein DJ, Jonker D, Mudenda J, Turunen T, Valtiņš K, Beinaroviča A, Grada L, Lahti M. Development of a Mobile Application for Detection of Adolescent Mental Health Problems and Feasibility Assessment with Primary Health Care Workers. Issues Ment Health Nurs 2022; 43:1046-1055. [PMID: 36205922 DOI: 10.1080/01612840.2022.2124003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods: Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results: The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion: HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.
Collapse
Affiliation(s)
- Gunter Groen
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Anja Dessauvagie
- Department of Social Work, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch, University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Grobler
- Clinical Unit, Psychiatry, Steve Biko Academic Hospital and Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| | - Ronelle Jansen
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Lonia Mwape
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | | | - Fabian Chapima
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Joonas Korhonen
- Nursing Science Department, Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Deborah Jonker
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John Mudenda
- Medical Education, Lusaka Apex Medical University, Lusaka, Zambia
| | | | | | | | | | - Mari Lahti
- Nursing Science Department, Health and Well-being, Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
7
|
Roth M, Lahti M, Gustafsson N, Berg J, Kaitala E, Kuosmanen L. Non-European immigrants' self-described strategies for mental health promotion and perceptions of Finnish mental health services: A qualitative descriptive analysis. Perspect Psychiatr Care 2022; 58:3016-3023. [PMID: 35445746 PMCID: PMC9790472 DOI: 10.1111/ppc.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/08/2022] [Accepted: 04/08/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This study aims to describe non-European immigrants' perceptions toward mental health care in Finland and the factors that support their mental health. DESIGN AND METHODS Participants (N = 17) were interviewed through semistructured interviews, after which interview transcripts were analyzed using a six-phase thematic analysis process. FINDINGS The participants reported that developing self-help strategies benefitted their mental health. The participants primarily preferred unprofessional help over professional mental health care. Several structural and cultural barriers to help-seeking were identified. PRACTICAL IMPLICATION Health care staff working with immigrants need proper education and knowledge to provide sufficient, holistic care; for this reason, information about the cultural differences among immigrants and cultural sensitivity should be included in basic as well as post-graduate nursing education.
Collapse
Affiliation(s)
- Minni Roth
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Noora Gustafsson
- Department of Nursing, Turku University of Applied Sciences, Turku, Finland
| | - Johanna Berg
- Department of Nursing, Turku University of Applied Sciences, Turku, Finland
| | - Elina Kaitala
- Department of Nursing, Turku University of Applied Sciences, Turku, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
8
|
Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in clinical practice of seclusion in psychiatric care. Eur Psychiatry 2022. [PMCID: PMC9566598 DOI: 10.1192/j.eurpsy.2022.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Seclusion is part of the clinical practice in European psychiatric hospital care with the aim to maintain the safety of patients and staff. Adverse events and harm have been reported for patients and staff resulting from seclusion. Safety hazards, which are the prerequisite of adverse events, can be identified using video observation methods. Identifying safety hazards can be used to prevent adverse events and improve the quality of psychiatric care. Objectives To identify safety hazards during seclusion in psychiatric hospital care. Methods Descriptive design with non-participant video-observation of seclusion care practice. Data consisted of video recordings (n = 36) from six wards of one psychiatric hospital in Finland. The data were analysed with inductive thematic analysis. Results Clinical practice of seclusion included safety hazards stemming from the actions of patients and staff. Patients’ actions were as follows: aggressive behaviour, attempting to escape, precarious movements, preventing the visibility of staff, exposing themselves to contamination, and falls during seclusion. Staff actions included: leaving dangerous items to seclusion, issues in the administration of medication, performing physical and mechanical restraints in unsecure way, and precarious movements and postures. Conclusions According to our results, the use of seclusion has safety hazards that can result in harm for patients and staff. To improve the quality and safety of seclusion in clinical practice, the guidelines, practices, and staff training need to consider the various safety hazards. While the work in Europe to abolish the use of seclusion is still in progress, this topic requires attention in clinical practice, education, and policymaking. Disclosure No significant relationships.
Collapse
|
9
|
Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
Collapse
Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| |
Collapse
|
10
|
Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution. J Psychiatr Ment Health Nurs 2022; 29:346-358. [PMID: 34032356 DOI: 10.1111/jpm.12773] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | | | - Jerry Allon
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
11
|
Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, der Vaart KJV, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students. Issues Ment Health Nurs 2021; 42:1095-1103. [PMID: 34156892 DOI: 10.1080/01612840.2021.1931583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Expert by Experience involvement in mental health nursing education is increasing in popularity as a teaching technique. The emerging literature attests to its benefits in enriching the educational experience for students. Much less attention has been devoted to the experience from the perspective of the Experts themselves. To address this gap and ensure this important perspective is captured and considered, the aim of this paper is to present the perceptions and experiences of Experts by Experience in delivering an educational module to mental health nursing students. A qualitative exploratory approach was adopted, involving in-depth individual interviews with Experts by Experience who delivered a learning module to nursing students in Australia and Europe. Data were analysed thematically. Analysis produced two overarching themes: Empowerment, and Challenges. Challenges included six sub-themes: Being constructive, not just critical; Time to unpack and reflect; Need for co-production and support from nursing academics; Emotional and practical support; maintaining personal boundaries; and adapting to the audience. These findings make a significant contribution to a broader understanding of Expert by Experience involvement in mental health education. The use of standards to maintain integrity and avoid tokenism is recommended.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Terri Warner
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Shifra Waks
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aine O'Donovan
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Fionnuala Manning
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Rory Doody
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Sonya Greaney
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - John Goodwin
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Chris Platania-Phung
- Department of Counselling, Australian College of Applied Psychology, Sydney, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Mari Lahti
- Faculty of Health and Social Sciences, Turku University of Applied Sciences, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
12
|
Korhonen J, Axelin A, Katajisto J, Lahti M. Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts. Nurs Open 2021; 9:966-977. [PMID: 34822738 PMCID: PMC8859090 DOI: 10.1002/nop2.1132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/10/2021] [Accepted: 10/31/2021] [Indexed: 01/10/2023] Open
Abstract
AIM The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia. DESIGN This cross-sectional study was conducted between October 2018 and December 2019. METHODS The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS. RESULTS Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.
Collapse
Affiliation(s)
- Joonas Korhonen
- Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | | |
Collapse
|
13
|
Murto T, Berglund M, Sakellari E, Lahti M. Domestic violence at "home sweet home"- More education and technology-based solutions needed in pandemic. Sex Reprod Healthc 2021; 30:100675. [PMID: 34741841 PMCID: PMC8564214 DOI: 10.1016/j.srhc.2021.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tiina Murto
- Turku University of Applied Sciences, Finland.
| | | | | | - Mari Lahti
- Turku University of Applied Sciences, Finland
| |
Collapse
|
14
|
Horgan A, O Donovan M, Manning F, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, Griffin M, MacGabhann L, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. 'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse. Int J Ment Health Nurs 2021; 30:136-147. [PMID: 32808438 DOI: 10.1111/inm.12768] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.
Collapse
Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Health and Medical Research Institute, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
15
|
Horgan A, Donovan MO, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, MacGabhann L, Russell S, Griffin M, Jan van der Vaart K, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. Improving Service User Involvement in Mental Health Nursing Education: Suggestions from Those with Lived Experience. Issues Ment Health Nurs 2021; 42:119-127. [PMID: 32717160 DOI: 10.1080/01612840.2020.1780529] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Service user involvement in mental health nursing education is increasing and a developing evidence base is demonstrating more positive attitudes towards people labelled with a mental illness. To date, most research on this approach has focussed on the perspectives of nursing students, with very limited research drawing on the expertise and opinions of service users. The aim of this study was to explore potential improvements in mental health nursing education, and ways service user involvement can be enhanced as defined by service users themselves. An international qualitative research project was undertaken involving focus groups with service users (n = 50) from Australia and five European countries. The research was coproduced between Experts by Experience (service users) and mental health nurse academics. Data were analysed thematically. Findings reflected two broad themes: (1) improvements to content, including: further emphasis on developing emotional intelligence, understanding mental distress and broader context of care; (2) Improvements to service user involvement, including: support, format, and teaching and learning techniques. These findings provide direction for maximising the benefits of service user involvement and show the value of the expertise of service users.
Collapse
Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden Canberra, Australia
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Hunter Medical Research Centre, and Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
16
|
Baxter MS, White A, Lahti M, Murto T, Evans J. Machine learning in a time of COVID-19 - Can machine learning support Community Health Workers (CHWs) in low and middle income countries (LMICs) in the new normal? J Glob Health 2021; 11:03017. [PMID: 33643627 PMCID: PMC7898557 DOI: 10.7189/jogh.11.03017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mats Stage Baxter
- Centre for Medical Informatics, Usher institute, The University of Edinburgh, Edinburgh, UK
| | - Alan White
- Institute of Applied Health Science, University of Aberdeen, Aberdeen, UK.,Interactive Health Ltd, Inverness, UK
| | - Mari Lahti
- Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Tiina Murto
- Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Jay Evans
- Global Health Academy, Usher Institute, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
17
|
Putkuri T, Salminen L, Axelin A, Lahti M. Good interaction skills are not enough - competency in mental health issues in child health clinics and school health services. Scand J Caring Sci 2021; 35:988-997. [PMID: 33403712 DOI: 10.1111/scs.12956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mental health problems among children and adolescents are a worldwide issue of concern. Health professionals who have sufficient competency in mental health issues are crucial for responding to this situation. AIM The aim of the study was to describe the competency in mental health issues required by the work of public health nurses in child health clinics and school health services. METHODS This qualitative, descriptive study was conducted with focus group interviews in March 2018. The sample consisted of public health nurses (n = 24) who were working in child health clinics or school health services in Finland. The data were analysed using inductive and deductive content analysis. RESULTS The competency in mental health issues required by the work of public health nurses was formulated from the identified strengths and topics required in continuing education. In total, 18 competencies were identified as covering mental health promotion, as well as the alleviation and treatment of symptoms and disorders. Intuitive and interpersonal competency was identified as the main strength of public health nurses. The theoretical and evidence-based competency regarding mental health issues was identified as a main topic needed in continuing education. CONCLUSION Public health nurses in child health clinics and school health services need competency in mental health issues for the promotion of mental health, the alleviation of symptoms and treatment of disorders. The results indicate that good interactional skills are not enough: the current competency of public health nurses in mental health issues is insufficient and does not meet the requirements of the work. The results were consistent with existing knowledge, but also provide a more comprehensive and precise insight into the current situation. In the future, the results should be verified with more studies. There is also a need for intervention studies aiming to improve competency in mental health issues.
Collapse
Affiliation(s)
- Tiina Putkuri
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku and Turku University of Applied Science, Turku, Finland
| |
Collapse
|
18
|
Happell B, Horgan A, Manning F, Doody R, Greaney S, Goodwin J, Bocking J, Waks S, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Experts by experience in mental health nursing education: What have we learned from the commune project? J Psychiatr Ment Health Nurs 2020; 27:675-677. [PMID: 32285986 DOI: 10.1111/jpm.12635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental Health Research Network, University College Cork, Cork, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia.,Australian College of Applied Psychology, Sydney, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
19
|
Horgan A, Manning F, Donovan MO, Doody R, Savage E, Bradley SK, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, MacGabhann L, Griffin M, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. Expert by experience involvement in mental health nursing education: The co-production of standards between Experts by Experience and academics in mental health nursing. J Psychiatr Ment Health Nurs 2020; 27:553-562. [PMID: 31989758 DOI: 10.1111/jpm.12605] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Expert by Experience (EBE) involvement in mental health nursing education has demonstrated benefits, including enhancing understanding of holistic and recovery-focused practice and enhanced application of interpersonal skills. Structure and support for EBE involvement is lacking; often resulting in inadequate preparation and debriefing and tokenistic involvement. Service user involvement in mental health nursing education should be underpinned by lived experience perspectives. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE An exploration of EBE involvement in nursing education from the perspective of those with lived experience. The development of standards designed to provide structure to better support future EBEs involved in higher education. An exemplar for co-production of standards between EBE and nurse academics which has applicability for other contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The standards could potentially strengthen EBE involvement in mental health nursing education, enhance their confidence and increase the retention of EBEs by creating an inclusive working culture. By increasing support for EBEs, the benefits to mental health nursing practice are likely to be maximized. ABSTRACT Introduction Involving people with lived experience of mental distress in mental health nursing education has gained considerable traction yet broader implementation remains ad hoc and tokenistic. Effective involvement requires curricula be informed by lived experience of service use. Aim To develop standards to underpin expert by experience involvement in mental health nursing education based on lived experience of service use. Methods Phase one used qualitative descriptive methods, involving focus groups with service users (n = 50) from six countries to explore perceptions of service user involvement in mental health nursing education. Phase two utilized these findings through consensus building to co-produce standards to support Experts by Experience involvement in mental health nursing education. Results Three themes emerged in Phase one: enablers and barriers, practical and informational support, and emotional and appraisal support. These themes underpinned development of the standards, which reflect nine processes: induction and orientation, external supervision, supportive teamwork, preparation for teaching and assessing, "intervision," mutual mentorship, pre- and post-debriefing, role clarity and equitable payment. Conclusions These standards form the framework entitled; Standards for Co-production of Education (Mental Health Nursing) (SCo-PE [MHN]). Implications for Practice The standards aim to support implementation of Expert by Experience roles in mental health nursing education.
Collapse
Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Annaliina Vatula
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Heikki Ellilä
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Mari Lahti
- Faculty of Medicine, Department of Nursing Science, Turku University, Turku University of Applied Sciences, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Health and Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
20
|
Happell B, Waks S, Horgan A, Greaney S, Manning F, Goodwin J, Bocking J, Scholz B, Hals E, Granerud A, Doody R, Platania-Phung C, Griffin M, Russell S, MacGabhann L, Pulli J, Vatula A, Browne G, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. "It is much more real when it comes from them": The role of experts by experience in the integration of mental health nursing theory and practice. Perspect Psychiatr Care 2020; 56:811-819. [PMID: 32166758 DOI: 10.1111/ppc.12496] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/28/2020] [Accepted: 02/25/2020] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To examine nursing students' perceptions of Experts by Experience impact on theoretical and practical learning. DESIGN AND METHODS Qualitative exploratory study involving focus groups with undergraduate nursing students from five European countries and Australia. Data were analyzed thematically. FINDINGS Participants described positive impacts as: bridging the theory and practice gap through first-hand experience, including sub-themes: bringing theory to life; can't be taught any other way, and innovative teaching methods fueling curiosity. RELEVANCE TO CLINICAL PRACTICE Integrating theory and practice is key for quality mental health nursing practice. Experts by experience can potentially contribute to reducing this enduring gap.
Collapse
Affiliation(s)
- Brenda Happell
- Faculty of Health and Medicine, School of Nursing and Midwifery, Hunter Institute of Medical Research, University of Newcastle University Drive, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, Expert by Experience lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland.,Area Lead for Mental Health Engagement, Southern Area Health Service Executive, Cork, Ireland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Graeme Browne
- Coordinator Port Macquarie Campus, Program Convenor, Masters Mental Health Nursing, School of Nursing & Midwifery, Port Macquarie, New South Wales, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
21
|
Varpula J, Välimäki M, Lantta T, Berg J, Lahti M. Nurses' perceptions of risks for occupational hazards in patient seclusion and restraint practices in psychiatric inpatient care: A focus group study. Int J Ment Health Nurs 2020; 29:703-715. [PMID: 32086881 DOI: 10.1111/inm.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
Seclusion and restraint are regularly used to manage patient aggression events in psychiatric inpatient care, despite occupational safety concerns. There is currently a lack of information on how nurses perceive the use of patient seclusion and restraint as a risk for occupational safety. The aim of this study is to describe the risks for occupational hazards in patient seclusion and mechanical restraint practices as well as ideas for improvement identified by nurses. A qualitative descriptive design was adopted, using focus groups comprising nurses (N = 32) working in psychiatric inpatient care. The data were analysed using inductive content analysis, and the results were reported using the consolidated criteria for reporting qualitative studies (COREQ). Four themes of risk for occupational hazards were identified: patient-induced, staff-induced, organization-induced, and environment-induced risks. One significant finding was that nurses described that their actions can strongly contribute to occupational hazards during seclusion and mechanical restraint practices. The nurses gave various ideas for how occupational safety could be improved during seclusion and mechanical restraint events, ideas involving staff, the organization, and environmental enhancements.
Collapse
Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Turku University of Applied Science, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Science, Turku, Finland
| |
Collapse
|
22
|
Lahti M, Groen G, Mwape L, Korhonen J, Breet E, Chapima F, Coetzee M, Ellilä H, Jansen R, Jonker D, Jörns-Presentati A, Mbanga I, Mukwato P, Mundenda J, Mutagubya J, Janse van Rensburg-Bonthuyzen E, Seedat S, Stein DJ, Suliman S, Sukwa T, Turunen TJ, Valtins K, van den Heuvel L, Wahila R, Grobler G. Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project. Issues Ment Health Nurs 2020; 41:24-30. [PMID: 31225763 DOI: 10.1080/01612840.2019.1604919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.
Collapse
Affiliation(s)
- Mari Lahti
- Turku University of Applied Science, Health and Well-being, Turku, Finland.,Department of Nursing, Turku University, Turku, Finland
| | - Gunter Groen
- Department of Social Science, Hamburg University of Applied Science, Hamburg, Germany
| | - Lonia Mwape
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Joonas Korhonen
- Turku University of Applied Science, Health and Well-being, Turku, Finland
| | - Elsie Breet
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Fabian Chapima
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Marita Coetzee
- Department of Nursing, University of Free State, Bloemfontein, South Africa
| | - Heikki Ellilä
- Turku University of Applied Science, Health and Well-being, Turku, Finland
| | - Ronelle Jansen
- Department of Nursing, University of Free State, Bloemfontein, South Africa
| | - Deporah Jonker
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Ireen Mbanga
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | | | - John Mundenda
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | - Joseph Mutagubya
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Thomas Sukwa
- Department of Nursing, Lusaka Apex Medical University, Lusaka, Zambia
| | - Timo-J Turunen
- International Cooperation and Foreign Students Department, Riga Technical University, Riga, Latvia
| | - Karlis Valtins
- International Cooperation and Foreign Students Department, Riga Technical University, Riga, Latvia
| | | | - Ruth Wahila
- Department of Nursing, University of Zambia, Lusaka, Zambia
| | - Gerhard Grobler
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
23
|
Bocking J, Happell B, Scholz B, Horgan A, Goodwin J, Lahti M, Platania-Phung C, MacGabhann L, Greaney S, Granerud A, Griffin M, Russell S, Bjornsson E, van der Vaart KJ, Ellilä H, Hals E, Doody R, Vatula A, Pulli J, Manning F, Allon J, Biering P. 'It is meant to be heart rather than head'; International perspectives of teaching from lived experience in mental health nursing programs. Int J Ment Health Nurs 2019; 28:1288-1295. [PMID: 31353779 DOI: 10.1111/inm.12635] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 01/10/2023]
Abstract
Consumer participation is a clear expectation of contemporary mental health policy. Most activity has concentrated in direct service delivery, and academic roles for mental health consumers have been slow to establish. An international project was undertaken to implement and evaluate meaningful consumer involvement in mental health nursing education. A learning module was co-produced between 'Experts by Experience' (drawing on experience of mental distress and service use) and Mental Health Nurse Academics. This qualitative exploratory study aimed to capture how Experts by Experience perceive their contribution. Interviews were undertaken with Experts by Experience who delivered the learning module. Data were analysed thematically and subsequently interpreted with Critical Social Theory. Two main themes emerged from the findings: 'there wasn't a barrier' described how personal narratives enhanced relationships between Experts by Experience and students; and 'made the human being visible', described their experiences of allowing students to see the person behind a diagnosis. These findings suggest Experts by Experience teaching is valuable and potentially a tool in redressing stigma. Addressing poor public perceptions could attract higher numbers of quality practitioners to mental health and meet identified workforce shortages. The findings presented here strengthen the evidence base for Expert by Experience roles in mental health professional education. These findings can be considered in international curricula reviews and aid progress towards a more socio-political, humanistic focus in mental health nursing, congruent with rights-based reform agendas.
Collapse
Affiliation(s)
- Julia Bocking
- ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia.,Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mari Lahti
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | | | - Heikki Ellilä
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Annaliina Vatula
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Jarmo Pulli
- Department of Nursing Science, Turku University of Applied Sciences, Turku, Finland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
24
|
Happell B, Waks S, Horgan A, Greaney S, Bocking J, Manning F, Goodwin J, Scholz B, Jan van der Vaart K, Allon J, Hals E, Granerud A, Doody R, Wai-Chi Chan S, Platania-Phung C, Griffin M, Russell S, MacGabhann L, Pulli J, Vatula A, Lahti M, Ellilä H, Browne G, Bjornsson E, Biering P. Expert by Experience Involvement in Mental Health Nursing Education: Nursing Students' Perspectives on Potential Improvements. Issues Ment Health Nurs 2019; 40:1026-1033. [PMID: 31498007 DOI: 10.1080/01612840.2019.1631417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Expert by experience involvement in mental health education for health professional programmes has increased in recent decades. The related literature has articulated the benefits, and changes in attitudes have been measured in some studies. Less attention has been devoted to ways this learning approach could be improved. The aim of this paper is to present the nursing students perspectives on how Expert by Experience input into nursing curricula could be enhanced. Qualitative exploratory research was undertaken, involving focus groups with students who had completed a mental health learning module co-produced by Experts by Experience and nurse academics. Results show two main themes: getting the structure right, and changes to content and approach. Some student responses could directly influence changes to the learning module. In other instances, responses indicate the need to better prepare students of the value of lived experience knowledge in its own right, rather than adjunct to more traditional methods of education. These findings are important in encouraging reflection on how future learning modules co-produced by Experts by Experience and Mental Health Nursing academics can be refined and better articulated.
Collapse
Affiliation(s)
- Brenda Happell
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julia Bocking
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sally Wai-Chi Chan
- University of Newcastle Singapore Operation, Singapore.,Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Graeme Browne
- School of Nursing & Midwifery, University of Newcastle, Port Macquarie, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
25
|
Korhonen J, Axelin A, Grobler G, Lahti M. Content validation of Mental Health Literacy Scale (MHLS) for primary health care workers in South Africa and Zambia ─ a heterogeneous expert panel method. Glob Health Action 2019; 12:1668215. [PMID: 31699016 PMCID: PMC6853208 DOI: 10.1080/16549716.2019.1668215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The lack of public knowledge and the burden caused by mental-health issues’ effect on developing and implementing adequate mental-health care for young and adolescent in low- and middle-income countries (LMIC). Primary health care could be the key in facing the challenge, but it suffers from insufficient resources and poor mental health literacy. This study’s aim was to adapt the content validity of the Mental Health Literacy Scale (MHLS) developed by O’Connor & Casey (2015) with researchers and primary health-care workers in low- and middle-income contexts in South Africa (SA) and in Zambia. Objectives: The study population comprised two expert panels (N = 21); Clinical Experts (CE) (n = 10) from Lusaka, Zambia and Professional Research Experts (PE) (n = 11) from the MEGA project management team were recruited to the study. Methods: MHLS was validated in a South African and a Zambian context using a heterogeneous expert-panel method. Participants were asked to rate the 35 MHLS items on a 4-point scale with 1 as not relevant and 4 as very relevant After the rating, all 35 MHLS items were carefully discussed by the expert panel and evaluated according their relevance. The data were analyzed using an item-level content validity index (I-CVI) and narrative and thematic analyses. Results: All 35 items ranked by the PREs met the cutoff criteria (≥0.8), and ten (n = 10) items were seen as relevant by CE when calculating I-CVIs. Based on the results of ratings and discussion, a group of sixteen (n = 16) of all items (n = 35) were retained as original without reviewing. A total of nineteen (n = 19) items were reviewed. Conclusion: This study found the MHLS to have sufficient validity in LMICs’ context but also recognized a gap between professional researchers’ and clinical workers’ knowledge and attitudes related to mental health.
Collapse
Affiliation(s)
- Joonas Korhonen
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Gerhard Grobler
- Department of Psychiatry, School of Medicine, University of Pretoria, Pretoria, South Africa
| | - Mari Lahti
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
26
|
Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, Chan SWC, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Browne G, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. “But I’m not going to be a mental health nurse”: nursing students’ perceptions of the influence of experts by experience on their attitudes to mental health nursing. J Ment Health 2019; 30:556-563. [DOI: 10.1080/09638237.2019.1677872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Brenda Happell
- Professor of Nursing and Equally Well Ambassador, School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, Australia
| | - Shifra Waks
- Consumer Academic, the University of Melbourne, Parkville, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, Expert by Experience Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Graeme Browne
- Masters Mental Health Nursing, School of Nursing & Midwifery, Coordinator Port Macquarie Campus
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
27
|
Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Jan van der Vaart K, Allon J, Lahti M, Pulli J, Vatula A, Ellilä H, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Assessment of the Opening Minds Scale for use with nursing students. Perspect Psychiatr Care 2019; 55:661-666. [PMID: 31169305 DOI: 10.1111/ppc.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/21/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Evaluate the validity of the Opening Minds Scale (OMS) for nursing students via Rasch models and confirmatory factor analysis (CFA). DESIGN AND METHODS Undergraduate nursing student responses to OMS (n = 423). Validity was evaluated via CFA and Rasch analysis. FINDINGS CFA results were strongest for a three-factor 13-item version of OMS. Rasch modeling supported sound properties for two of three scales. Internal reliabilities ranged between 0.6 and 0.7. PRACTICE IMPLICATIONS OMS has potential as a valid measure for stigma research and antistigma program evaluation. Rasch analysis suggest it is inappropriate to use a total OMS score for nursing student populations.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | - Julia Bocking
- School of Health Sciences, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
28
|
Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, MacGabhann L, Russell S, Griffin M, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. "I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience". J Psychiatr Ment Health Nurs 2019; 26:233-243. [PMID: 31220380 DOI: 10.1111/jpm.12540] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Parkville, Victoria, Australia
| | - Julia Bocking
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
29
|
Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Granerud A, Hals E, Doody R, Russell S, Griffin M, MacGabhann L, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. 'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education. Int J Ment Health Nurs 2019; 28:950-959. [PMID: 30953420 DOI: 10.1111/inm.12596] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Bocking
- Medical School, Australian National University, Acton, Canberra, Australian Capital Territory, Australia.,Faculty of Health, University of Canberra, University Drive, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- Mental Health Practice, Healthy Living Centre, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
30
|
Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Vatula A, Ellilä H, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Nursing student attitudes to people labelled with 'mental illness' and consumer participation: A survey-based analysis of findings and psychometric properties. Nurse Educ Today 2019; 76:89-95. [PMID: 30776534 DOI: 10.1016/j.nedt.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Understanding student attitudes towards people diagnosed with mental illness is central to realising evidence-based nursing education and policy at an international level. Redressing stigmatised views can assist in preparing nursing students to work in mental health settings and support the active involvement of consumers in all aspects of mental health service delivery (known as: consumer participation) at individual and systemic levels. Accurate research on nursing student attitudes is dependent on the availability of valid and reliable measures. OBJECTIVES Using data from and international study, this research sought to: (1) evaluate two measures of nurse student attitudes, and (2) explore whether attitudes to people labelled with a diagnosis of mental illness and who use mental health services is associated with more positive attitudes to consumer participation in mental health services. DESIGN Self-report quantitative data gained via the Consumer Participation Questionnaire (CPQ) and Mental Health Nurse Education Survey (MHNES). SETTING AND PARTICIPANTS University nursing students in Australia and Western Europe. DATA Pooled CPQ and MHNES data from Australia, Ireland, Finland, Norway and the Netherlands. METHODS The MHNES and CPQ were evaluated via exploratory factor analysis and Rasch modelling. Hierarchical regression was applied to see whether attitudes to mental illness and mental health practice relate to attitudes to consumer participation after addressing demographic differences. RESULTS Refined MHNES scales demonstrated overall fit on Rasch models. Reliabilities for MHNES ranged from 0.82 to 0.73. Perceived value of mental health nursing to consumers and lower negative stereotypes were associated with positive attitudes to consumer participation independent of age, gender and country [F (9, 381) = 15.78, p < .001]. Students who considered mental health nursing made a valuable contribution represented the strongest association with a positive attitude towards consumer participation. CONCLUSIONS Differences in openness to consumer participation are partly attributable to views about people diagnosed with mental illness and the perception that mental health practice makes a positive difference to these people within health service contexts.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia.
| | - Julia Bocking
- School of Health Sciences, University of Canberra, Faculty of Health, Australia.
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway.
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway.
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland.
| | - Jarmo Pullo
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland; Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland.
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland.
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland.
| |
Collapse
|
31
|
Happell B, Platania-Phung C, Scholz B, Bocking J, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Vatula A, Koski J, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study. Int J Ment Health Nurs 2019; 28:480-491. [PMID: 30390371 DOI: 10.1111/inm.12551] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 11/27/2022]
Abstract
Reform to nursing education is essential to ensure future generations of nurses are strongly positioned to value, know, and deliver strength-based, recovery-oriented mental health practice. A promising pathway to effectively drive reform is the coproduction of curricula by nursing academics and people with lived experience of recovery from mental distress referred to as Experts by Experience. The Co-production in Mental Health Nursing Education (COMMUNE) project is an international collaboration for development and implementation of consumer coproduced curricula. This study evaluated the inclusion of Expert by Experience-led mental health nursing education on nursing students' attitudes to people labelled with mental illness, mental health nursing, and consumer participation. A repeated self-report measures design was implemented in Australia, Ireland, and Finland to ascertain level of generalizability of consumer involvement within undergraduate nursing programmes. Data were collected from nursing students (n = 194) immediately before and after the education module, using three self-report instruments on attitudes (Mental Health Nurse Education Survey, Consumer Participation Questionnaire, and Opening Minds Scale). Data were analysed using descriptive and inferential statistics. Eighty-nine per cent of the 27 points of change reflected more favourable and accepting attitudinal change. Of these, 41% were significant at Bonferroni adjusted alpha of 0.0025. There was a statistically significant increase in preparedness for practice in the mental health field in each of the three countries. The most pronounced change is related to the social and systemic inclusion of people with a diagnostic label and recovery-oriented care more broadly.
Collapse
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australian Capital Territory, Australia
| | - Julia Bocking
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, Faculty of Health, and ACT Health, Building 6, Level 3, Canberra Hospital, Woden Canberra, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pullo
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Johanna Koski
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Martha Griffin
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
32
|
Happell B, Platania-Phung C, Bocking J, Scholz B, Horgan A, Manning F, Doody R, Hals E, Granerud A, Lahti M, Pullo J, Ellilä H, Annaliina V, van der Vaart KJ, Allon J, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. Nursing Students' Attitudes Towards People Diagnosed with Mental Illness and Mental Health Nursing: An International Project from Europe and Australia. Issues Ment Health Nurs 2018; 39:829-839. [PMID: 30346220 DOI: 10.1080/01612840.2018.1489921] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students' attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim.
Collapse
Affiliation(s)
- Brenda Happell
- a School of Nursing and Midwifery , the University of Newcastle, Callaghan , New South Wales , Australia
| | - Chris Platania-Phung
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Julia Bocking
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Brett Scholz
- b Synergy: Nursing and Midwifery Research Centre , University of Canberra, Faculty of Health, and ACT Health , WODEN , Australia
| | - Aine Horgan
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Fionnuala Manning
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Rory Doody
- c School of Nursing and Midwifery , University College Cork , Cork , Ireland
| | - Elisabeth Hals
- d Faculty of Health and Social Sciences , Inland Norway University of Applied Sciences , Hedmark , Norway
| | - Arild Granerud
- d Faculty of Health and Social Sciences , Inland Norway University of Applied Sciences , Hedmark , Norway
| | - Mari Lahti
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Jarmo Pullo
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Heikki Ellilä
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | - Vatula Annaliina
- e Turku University of Applied Sciences, Turku, Finland, Faculty of Medicine, Department of Nursing Science , Turku University , Turku , Finland
| | | | - Jerry Allon
- f Institute for Nursing Studies, University of Applied Sciences Utrecht , Utrecht , the Netherlands
| | - Martha Griffin
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Siobhan Russell
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Liam MacGabhann
- g School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Einar Bjornsson
- h Department of Nursing , University of Iceland , Reykjavik , Iceland
| | - Pall Biering
- h Department of Nursing , University of Iceland , Reykjavik , Iceland
| |
Collapse
|
33
|
Lahti M, Linno M, Pael J, Lenk-Adusoo M, Timonen-Kallio E. Mental Health Care Interventions in Child Welfare: Integrative Review of Evidence-Based Literature. Issues Ment Health Nurs 2018; 39:746-756. [PMID: 30153073 DOI: 10.1080/01612840.2018.1479902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Many of the youths living in vulnerable environments in child welfare settings are in need of psychiatric treatment as well as child protection services. There is an urgent demand for closer collaboration between these two sectors in order to ensure more effective work in child welfare regarding to mental health care interventions is provided. The aim of this integrative review was to describe the evidence-based literature related to mental health care interventions provided in child welfare. Seven databases (PubMed, EBSCOhost, Ovid MEDLINE, Eric, CINAHL, Elsevier Science Direct, Cochrane database) were searched, while search parameters included English-only manuscripts published prior to 20 May 2016. Out of 152 records, only eight studies met the inclusion criteria. Mental health care interventions described varied and were listed as follows: crisis assessment, respite child care, counselling, therapeutic interviews, cognitive and educational screening, different therapies, psychoeducational support, psychological testing, behavioural assessment, individual work and brief interval care. Despite using comprehensive searches in seven databases, we found only eight studies related to acute psychiatric services targeted at child welfare. There is not enough evidence to arrive at a definite conclusion on the effects of mental health care interventions in child welfare.
Collapse
Affiliation(s)
- Mari Lahti
- a Health and Well-being , Turku University of Applied Science , Turku , Finland.,b Department of Nursing Science , University of Turku , Turku , Finland
| | - Merle Linno
- c Department of Social Sciences , University of Tarto , Tarto , Estonia
| | - Janika Pael
- d Department of Nursing , Tartu Health Care College , Tarto , Estonia
| | | | - Eeva Timonen-Kallio
- a Health and Well-being , Turku University of Applied Science , Turku , Finland
| |
Collapse
|
34
|
Horgan A, Manning F, Bocking J, Happell B, Lahti M, Doody R, Griffin M, Bradley SK, Russell S, Bjornsson E, O'Donovan M, MacGabhann L, Savage E, Pulli J, Goodwin J, van der Vaart KJ, O'Sullivan H, Dorrity C, Ellila H, Allon J, Hals E, Sitvast J, Granerud A, Biering P. 'To be treated as a human': Using co-production to explore experts by experience involvement in mental health nursing education - The COMMUNE project. Int J Ment Health Nurs 2018; 27:1282-1291. [PMID: 29377483 DOI: 10.1111/inm.12435] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/17/2017] [Indexed: 12/30/2022]
Abstract
Increasingly, experts as deemed by personal experience or mental health service use, are involved in the education of nurses; however, accompanying research is limited and focuses primarily on opinions of nurse educators and students. The aim of this study was to develop an understanding of the potential contribution to mental health nursing education by those with experience of mental health service use. The research was part of the international COMMUNE (Co-production of Mental Health Nursing Education) project, established to develop and evaluate co-produced mental health content for undergraduate nursing students. A qualitative descriptive design was adopted with data collected through focus group interviews in seven sites across Europe and Australia. Experts by experience (people with experience of distress, service use, and recovery) co-produced the project in partnership with nursing academics. Co-production enriched the process of data collection and facilitated the analysis of data from multiple perspectives. Two themes are presented in this paper. The first focuses on how experts by experience can enhance students' understanding of recovery by seeing the strengths inherent in the 'human' behind the diagnostic label. The second highlights the importance of communication and self-reflection on personal values, where students can explore their own thoughts and feelings about mental distress alongside those with lived experience. Interacting with experts by experience in the classroom can assist in challenging stigmatizing attitudes prior to nursing placements. These findings can be used to inform international nursing curricula by increasing the focus on nursing skills valued by those who use the services.
Collapse
Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Julia Bocking
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Brenda Happell
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Martha Griffin
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Stephen K Bradley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Siobhan Russell
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Moira O'Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Liam MacGabhann
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Heikki Ellila
- Turku University of Applied Sciences, Turku, Finland
| | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jan Sitvast
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
35
|
Skärsäter I, Keogh B, Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Meade O, Sitvast J, Stickley T, Kilkku N. Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: A critical review of the literature. Nurse Educ Pract 2018; 32:138-146. [PMID: 30007849 DOI: 10.1016/j.nepr.2018.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 01/21/2023]
Abstract
Involving and supporting the family members and caregivers of people with mental illness is essential to high-quality mental health services. However, literature suggests that there is a lack of engagement between family members and mental health nurses (MHNs). Lack of knowledge among MHNs is often cited as one of the main reasons for this lack of engagement. The aim of this review was to explore the knowledge, skills and attitudes that are required by MHNs to enable to them to work more effectively with families affected by mental illness. A literature based critical review was used to access and review 35 papers in order to extract concepts that could inform the design of eLearning materials to assist MHNs advance their knowledge in this area. Two overarching themes were identified; 'Mental health problems and the family' and 'Working with the family'. From these themes, the knowledge, skills and attitudes required to work more effectively with families are described. The findings from this review provide a descriptive account of the knowledge skills and attitudes that are required for effective family work. In addition, the review provides an empirical foundation for education programmes in the area.
Collapse
Affiliation(s)
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Heikki Ellilä
- University of Applied Science Turku, Ruiskatu 8, 20810, Turku, Finland
| | | | - Mari Lahti
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Agnes Higgins
- Halmstad University, Box 823, SE 301 18, Halmstad, Sweden
| | - Oonagh Meade
- School of Psychology, National University of Ireland, Galway, Ireland.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ, Utrecht, The Netherlands
| | - Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520, Tampere, Finland
| |
Collapse
|
36
|
Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Keogh B, Meade O, Sitvast J, Skärsäter I, Stickley T, Kilkku N. Preparing master-level mental health nurses to work within a wellness paradigm: Findings from the eMenthe project. Int J Ment Health Nurs 2018; 27:823-832. [PMID: 28786212 DOI: 10.1111/inm.12370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/27/2022]
Abstract
Mental health promotion remains an important component of mental health nursing practice. Supporting wellness at both the individual and societal levels has been identified as one of the key tenets of mental health promotion. However, the prevailing biomedical paradigm of mental health education and practice has meant that many nurses have not been equipped to incorporate a wellness perspective into their mental health practice. In the present study, we report on an exploratory study which details the knowledge, skills, and attitudes required by master-level mental health nurses to practice within a wellness paradigm from the perspective of three groups of key stakeholders: (i) service users and family members (n = 23); (ii) experienced mental health nurses (n = 49); and (iii) master-level mental health nursing students (n = 37). The findings, which were reported from individual and focus group interviews across five European countries, suggested a need to reorientate mental health nursing education to include a focus on wellness and resilience to equip mental health nurses with the skills to work within a strengths-based, rather than a deficits-based, model of mental health practice. Key challenges to working within a wellness paradigm were identified as the prevailing dominance of the biomedical model of cause and treatment of mental health problems, which focusses on symptoms, rather than the holistic functioning of the individual, and positions the person as passive in the nurse-service user relationship.
Collapse
Affiliation(s)
- Louise Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Heikki Ellilä
- School of Health and Wellbeing, Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- School of Health and Wellbeing, Turku University of Applied Sciences, Turku, Finland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Oonagh Meade
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jan Sitvast
- Master Program in Advanced Nursing Practice, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - Ingela Skärsäter
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Theo Stickley
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nina Kilkku
- School of Healthcare, Tampere University of Applied Sciences, Tampere, Finland
| |
Collapse
|
37
|
Jormfeldt H, Doyle L, Ellilä H, Lahti M, Higgins A, Keogh B, Meade O, Stickley T, Sitvast J, Skärsäter I, Kilkku N. Master's level mental health nursing competencies, a prerequisite for equal health among service users in mental health care. Int J Qual Stud Health Well-being 2018; 13:1502013. [PMID: 30067476 PMCID: PMC6084491 DOI: 10.1080/17482631.2018.1502013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging. METHODS Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services. RESULTS The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care. CONCLUSION This discussion paper shapes implications for developments in master's level mental health nursing education curricula.
Collapse
Affiliation(s)
- Henrika Jormfeldt
- School of Health and Wellfare, Halmstad University, Halmstad, Sweden
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Heikki Ellilä
- Health and Well-being, Turku University of Applied Science, Turku, Finland
| | - Mari Lahti
- Health and Well-being, Turku University of Applied Science, Turku, Finland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Oonagh Meade
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Jan Sitvast
- Advanced Nursing Practice, University of Applied Sciences HU, Utrecht, The Netherlands
| | - Ingela Skärsäter
- School of Health and Wellfare, Halmstad University, Halmstad, Sweden
| | - Nina Kilkku
- Tampere University of Applied Sciences, Tampere, Finland
| |
Collapse
|
38
|
Välimäki M, Anttila K, Anttila M, Lahti M. Web-Based Interventions Supporting Adolescents and Young People With Depressive Symptoms: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2017; 5:e180. [PMID: 29222079 PMCID: PMC5741826 DOI: 10.2196/mhealth.8624] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although previous studies on information and communication technology (ICT)-based intervention on mental health among adolescents with depressive symptoms have already been combined in a number of systematic reviews, coherent information is still missing about interventions used, participants' engagement of these interventions, and how these interventions work. OBJECTIVE We conducted a systematic review and meta-analysis of trials to describe the effectiveness of Web-based interventions to support adolescents with depression or depressive symptoms, anxiety, and stress. We also explored the content of the interventions, as there has previously been a lack of coherent understanding of the detailed content of the Web-based interventions for these purposes. METHODS We included parallel randomized controlled trials targeted at adolescents, or young people in the age range of 10 and 24 years, with symptoms or diagnoses of depression and anxiety. The interventions were from original studies aimed to support mental health among adolescents, and they were delivered via Web-based information and communication technology. RESULTS Out of 2087 records identified, 27 papers (22 studies) met the inclusion criteria. On the basis of a narrative analysis of 22 studies, a variety of Web-based interventions were found; the most commonly used intervention was based on cognitive behavioral therapy. Meta-analysis was further conducted with 15 studies (4979 participants). At the end of the intervention, a statistically significant improvement was found in the intervention group (10 studies) regarding depressive symptoms (P=.02, median 1.68, 95% CI 3.11-0.25) and after 6 months (3 studies; P=.01, median 1.78, 95% CI 3.20-0.37). Anxiety symptoms (8 studies; P<.001, median 1.47, 95% CI 2.36-0.59) and moods and feelings (2 studies; P=.04, median 5.55, 95% CI 10.88-0.22) improved as well in the Web-based intervention group, but there was no difference in stress scores. However, adolescents in the intervention group left the study early more often, both in short-term studies (11 studies; P=.007, median 1.31, 95% CI 1.08-1.58) and mid-term studies (3 studies; P=.02, median 1.65, 95% CI 1.09-2.49). We did not find any studies that had assessed the costs of the Web-based interventions. CONCLUSIONS Despite widely reported promises that information technology use is beneficial to adolescents with depression, the results of our review show only short-term effects on adolescents' mental well-being, whereas long-term effects remain questionable because of the limited number of studies reviewed. Information about the economic benefits of Web-based interventions is still lacking. The quality of the studies, especially biases related to attrition rates and selective reporting, still needs serious attention.
Collapse
Affiliation(s)
- Maritta Välimäki
- Hong Kong Polytechnic University, Hong Kong, China.,Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Katriina Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Division of Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Science, Turku, Finland
| |
Collapse
|
39
|
Kuula L, Merikanto I, Makkonen T, Halonen R, Lahti M, Lahti J, Heinonen K, Räikkönen K, Pesonen AK. Schizotypal traits are associated with sleep spindles and REM in adolescence. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Keogh B, Skärsäter I, Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Meade O, Sitvast J, Stickley T, Kilkku N. Working with Families Affected by Mental Distress: Stakeholders' Perceptions of Mental Health Nurses Educational Needs. Issues Ment Health Nurs 2017; 38:822-828. [PMID: 28745973 DOI: 10.1080/01612840.2017.1341587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Family and informal caregivers provide a substantial amount of care and support to people who experience mental health problems. The aim of this study was to explore mental health nurses', students' and service users' perceptions of the knowledge, skills and attitudes that are required by mental health nurses to work with families and carers using a qualitative methodology. Three themes emerged from the data: Knowledge of the family and how mental distress affects the family; working with the family - support and education; and valuing the role of the family. The three themes demonstrate the complexity of preparing mental health nurses to work with families and carers, and the article offers recommendations about how this might be achieved.
Collapse
Affiliation(s)
- Brian Keogh
- a School of Nursing and Midwifery , Trinity College Dublin , Dublin , Ireland
| | - Ingela Skärsäter
- b School of Health and Welfare , Halmstad University , Halmstad , Sweden
| | - Louise Doyle
- a School of Nursing and Midwifery , Trinity College Dublin , Dublin , Ireland
| | - Heikki Ellilä
- c School of Health and Wellbeing , University of Applied Science Turku , Turku , Finland
| | - Henrika Jormfeldt
- b School of Health and Welfare , Halmstad University , Halmstad , Sweden
| | - Mari Lahti
- d University of Applied Science Turku , Turku , Finland
| | - Agnes Higgins
- a School of Nursing and Midwifery , Trinity College Dublin , Dublin , Ireland
| | - Oonagh Meade
- e School of Health Sciences, Faculty of Medicine and Health Sciences, Institute of Mental Health Building , University of Nottingham , Innovation Park , UK
| | - Jan Sitvast
- f Master Program in Advanced Nursing Practice , University of Applied Sciences HU , Utrecht , The Netherlands
| | | | - Nina Kilkku
- g Tampere University of Applied Sciences , Tampere , Finland
| |
Collapse
|
41
|
Affiliation(s)
- S. Smalley
- Jeremiah Horrocks Institute for Mathematics, Physics and Astronomy, University of Central Lancashire, Preston PR1 2HE, United Kingdom
| | - M. Lahti
- Department of Mathematics and Physics, Lappeenranta University of Technology, P.O. Box 20, Lappeenranta FIN-53851, Finland
| | - K. Pussi
- Department of Mathematics and Physics, Lappeenranta University of Technology, P.O. Box 20, Lappeenranta FIN-53851, Finland
| | - V. R. Dhanak
- Stephenson Institute for Renewable Energy and Department of Physics, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - J. A. Smerdon
- Jeremiah Horrocks Institute for Mathematics, Physics and Astronomy, University of Central Lancashire, Preston PR1 2HE, United Kingdom
| |
Collapse
|
42
|
Lahti M, Haapaniemi-Kahala H, Salminen L. Use of Social Media By Nurse Educator Students: An Exploratory Survey. Open Nurs J 2017; 11:26-33. [PMID: 28400892 PMCID: PMC5362977 DOI: 10.2174/1874434601711010026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Information and Communication Technology (ICT) opens up new possibilities for introducing innovative teaching and learning methods to deliver education in different educational areas. Use of internet and social media has grown rapidly and is a key way in how nurses and nurse educator students find information. However, the evidence is still lacking how nurse educator students use social media. OBJECTIVE The aim of this study is to describe nurse educator students' use of social media and the ways in which their educational needs are related to social media. METHOD The data were collected using a structured questionnaire that included one open question. Altogether, 49 nurse educator students completed and returned the questionnaire (response rate 96%). The quantitative data were analysed using statistical programme SPPS and content analysis. RESULTS While many nurse educator students reported using the tools of social media, others claimed that they do not use social media at all. Facebook was most common (53% use it every day) and YouTube (17%) the second most common form of social media used to support daily living. The participants reported using YouTube (6% use it every day) and Facebook (4%) most often as support in their studies. They reported using Second life as virtual reality form of social media, the least. The most common educational needs of nurse educator students include receiving more in-depth information about how to use social media, as well as more practice in using it. CONCLUSION In the future, the education of the nurse educator students should include even more in-depth information about the forms of social media and about the advantages of using it in teaching. The education should encourage nurse educator students and provide them with more possibilities to train and make use of the benefits of social media as support in their daily lives and studies. There is need for more robust evidence of social media use in nurse educator students education.
Collapse
Affiliation(s)
- Mari Lahti
- Post-Doc researcher, Department of Nursing Science, University of Turku, Finland, Senior lecture in Turku University of Applied Science, Finland
| | | | - Leena Salminen
- University Lecturer, Department of Nursing Science, University of Turku, Finland
| |
Collapse
|
43
|
Mina TH, Lahti M, Drake AJ, Räikkönen K, Minnis H, Denison FC, Norman JE, Reynolds RM. Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children. Psychol Med 2017; 47:353-362. [PMID: 27776561 DOI: 10.1017/s0033291716002452] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prenatal maternal obesity has been linked to adverse childhood neuropsychiatric outcomes, including increased symptoms of attention deficit hyperactivity disorder (ADHD), internalizing and externalizing problems, affective disorders and neurodevelopmental problems but few studies have studied neuropsychiatric outcomes among offspring born to very severely obese women or assessed potential familial confounding by maternal psychological distress. METHOD We evaluated neuropsychiatric symptoms in 112 children aged 3-5 years whose mothers had participated in a longitudinal study of obesity in pregnancy (50 very severe obesity, BMI ⩾40 kg/m2, obese class III and 62 lean, BMI 18.5-25 kg/m2). The mothers completed the Conners' Hyperactivity Scale, Early Symptomatic Syndrome Eliciting Neurodevelopmental Clinical Examination Questionnaire (ESSENCE-Q), Child's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), and Child Behavior Checklist (CBCL) to assess child neuropsychiatric symptoms. Covariates included child's sex, age, birthweight, gestational age, socioeconomic deprivation levels, maternal age, parity, smoking status during pregnancy, gestational diabetes and maternal concurrent symptoms of anxiety and depression assessed using State Anxiety of Spielberger State-Trait Anxiety Index (STAI) and General Health Questionnaire (GHQ), respectively. RESULTS Children exposed to prenatal maternal very severe obesity had significantly higher scores in the Conners' Hyperactivity Scale; ESSENCE-Q; total sleep problems in CSHQ; hyperactivity, conduct problems and total difficulties scales of the SDQ; higher externalizing and total problems, anxious/depressed, aggressive behaviour and other problem syndrome scores and higher DSM-oriented affective, anxiety and ADHD problems in CBCL. Prenatal maternal very severe obesity remained a significant predictor of child neuropsychiatric problems across multiple scales independent of demographic factors, prenatal factors and maternal concurrent symptoms of anxiety and depression. CONCLUSIONS Prenatal maternal very severe obesity is a strong predictor of increased neuropsychiatric problems in early childhood.
Collapse
Affiliation(s)
- T H Mina
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - M Lahti
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - A J Drake
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| | - K Räikkönen
- Institute of Behavioural Sciences,University of Helsinki,Helsinki,Finland
| | - H Minnis
- Institute of Health and Wellbeing,University of Glasgow,Glasgow, Scotland,UK
| | - F C Denison
- MRC Centre for Reproductive Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh, Scotland,UK
| | - J E Norman
- MRC Centre for Reproductive Health,Queen's Medical Research Institute,University of Edinburgh,Edinburgh, Scotland,UK
| | - R M Reynolds
- University BHF Centre for Cardiovascular Sciences, Queen's Medical Research Institute, University of Edinburgh,Edinburgh, Scotland,UK
| |
Collapse
|
44
|
Lahti M, Pussi K, Smerdon JA, Young KM, Sharma HR, McGrath R. Coverage-dependent structural phase transformations in the adsorption of pentacene on an aperiodically modulated Cu film. J Chem Phys 2016; 145:154707. [PMID: 27782456 DOI: 10.1063/1.4964920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Surface ordering of pentacene molecules adsorbed on an aperiodic Cu surface has been studied with density functional theory (DFT) and scanning tunnelling microscopy as a function of coverage. Below 0.73 ML (5.3 × 1013 molecules cm-2), the adsorbate structure is row-like with the molecular axes aligned with the rows in the Cu structure. Between this coverage and 1 ML (7.3 × 1013 molecules cm-2), a structural phase with a checkerboard structure is seen. At this coverage region, the molecules are very close to each other which leads to unusual bending. At higher coverages, a further phase transition to a high-density row structure is seen for most of the film. DFT with van der Waals functionals is employed to study how the molecule-molecule and molecule-surface interactions evolve as a function of coverage.
Collapse
Affiliation(s)
- M Lahti
- School of Engineering Science, Lappeenranta University of Technology, P.O. Box 20, FIN-53851 Lappeenranta, Finland
| | - K Pussi
- School of Engineering Science, Lappeenranta University of Technology, P.O. Box 20, FIN-53851 Lappeenranta, Finland
| | - J A Smerdon
- Jeremiah Horrocks Institute for Mathematics, Physics and Astronomy, University of Central Lancashire, Preston PR1 2HE, United Kingdom
| | - K M Young
- Surface Science Research Centre, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - H R Sharma
- Surface Science Research Centre, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - R McGrath
- Surface Science Research Centre, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| |
Collapse
|
45
|
Heinonen K, Kajantie E, Pesonen AK, Lahti M, Pirkola S, Wolke D, Lano A, Sammallahti S, Lahti J, Andersson S, Eriksson JG, Raikkonen K. Common mental disorders in young adults born late-preterm. Psychol Med 2016; 46:2227-2238. [PMID: 27109930 DOI: 10.1017/s0033291716000830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Results of adulthood mental health of those born late-preterm (34 + 0-36 + 6 weeks + days of gestation) are mixed and based on national registers. We examined if late-preterm birth was associated with a higher risk for common mental disorders in young adulthood when using a diagnostic interview, and if this risk decreased as gestational age increased. METHOD A total of 800 young adults (mean = 25.3, s.d. = 0.62 years), born 1985-1986, participated in a follow-up of the Arvo Ylppö Longitudinal Study. Common mental disorders (mood, anxiety and substance use disorders) during the past 12 months were defined using the Composite International Diagnostic Interview (Munich version). Gestational age was extracted from hospital birth records and categorized into early-preterm (<34 + 0, n = 37), late-preterm (34 + 0-36 + 6, n = 106), term (37 + 0-41 + 6, n = 617) and post-term (⩾42 + 0, n = 40). RESULTS Those born late-preterm and at term were at a similar risk for any common mental disorder [odds ratio (OR) 1.11, 95% confidence interval (CI) 0.67-1.84], for mood (OR 1.11, 95% CI 0.54-2.25), anxiety (OR 1.00, 95% CI 0.40-2.50) and substance use (OR 1.31, 95% CI 0.74-2.32) disorders, and co-morbidity of these disorders (p = 0.38). While the mental disorder risk decreased significantly as gestational age increased, the trend was driven by a higher risk in those born early-preterm. CONCLUSIONS Using a cohort born during the advanced neonatal and early childhood care, we found that not all individuals born preterm are at risk for common mental disorders in young adulthood - those born late-preterm are not, while those born early-preterm are at a higher risk. Available resources for prevention and intervention should be targeted towards the preterm group born the earliest.
Collapse
Affiliation(s)
- K Heinonen
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,Helsinki,Finland
| | - A-K Pesonen
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| | - M Lahti
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| | - S Pirkola
- National Institute for Health and Welfare,Helsinki,Finland
| | - D Wolke
- Department of Psychology,University of Warwick,Coventry,UK
| | - A Lano
- Children's Hospital, Helsinki University Hospital and University of Helsinki,Helsinki,Finland
| | - S Sammallahti
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| | - J Lahti
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| | - S Andersson
- Children's Hospital, Helsinki University Hospital and University of Helsinki,Helsinki,Finland
| | - J G Eriksson
- National Institute for Health and Welfare,Helsinki,Finland
| | - K Raikkonen
- Institute of Behavioural Sciences, University of Helsinki,Helsinki,Finland
| |
Collapse
|
46
|
Välimäki M, Athanasopoulou C, Lahti M, Adams CE. Effectiveness of Social Media Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e92. [PMID: 27105939 PMCID: PMC4859871 DOI: 10.2196/jmir.5385] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background Recent studies have shown that people with serious mental disorders spend time online for the purposes of disclosure, information gathering, or gaming. However, coherent information on the effects of social media on treatment for people with schizophrenia is still lacking. Objective Our aim was to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Methods A systematic review and meta-analysis were undertaken to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Ten databases were searched, while search parameters included English-only manuscripts published prior to June 25, 2015. Study appraisals were made independently by 2 reviewers, and qualitative and quantitative syntheses of data were conducted. Results Out of 1043 identified records, only two randomized studies of moderate quality (three records, total N=331, duration 12 months) met the inclusion criteria. Participants were people with schizophrenia spectrum or an affective disorder. Social media was used as part of Web-based psychoeducation, or as online peer support (listserv and bulletin board). Outcome measures included perceived stress, social support, and disease-related distress. At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress levels (
P=.04) and showed a trend for a higher perceived level of social support (
P=.06). However, those who reported more positive experiences with the peer support group also reported higher levels of psychological distress (
P=.01). Conclusions Despite using comprehensive searches from 10 databases, we found only two studies, whereas numerous reports have been published citing the benefits of social media in mental health. Findings suggest the effects of social media interventions are largely unknown. More research is needed to understand the effects of social media, for users with and without mental illness, in order to determine the impact on mental well-being ofsocial media use as well as its risks.
Collapse
Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.
| | | | | | | |
Collapse
|
47
|
Stickley T, Higgins A, Meade O, Sitvast J, Doyle L, Ellilä H, Jormfeldt H, Keogh B, Lahti M, Skärsäter I, Vuokila-Oikkonen P, Kilkku N. From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project. Nurse Educ Today 2016; 37:155-163. [PMID: 26687142 DOI: 10.1016/j.nedt.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/29/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.
Collapse
Affiliation(s)
- Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, Nottingham, NG7 2TU, United Kingdom.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Oonagh Meade
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ Utrecht, The Netherlands.
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Heikki Ellilä
- Dep. Health and Wellbeing, Turku University of Applied Sciences, Ruiskatu 2, 20720 Turku, Finland.
| | | | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin 2, Ireland.
| | - Mari Lahti
- University of Applied Science Turku, Ruiskatu 8, 20810 Turku, Finland.
| | | | | | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland.
| |
Collapse
|
48
|
Räikkönen K, Pesonen AK, O'Reilly JR, Tuovinen S, Lahti M, Kajantie E, Villa P, Laivuori H, Hämäläinen E, Seckl JR, Reynolds RM. Maternal depressive symptoms during pregnancy, placental expression of genes regulating glucocorticoid and serotonin function and infant regulatory behaviors. Psychol Med 2015; 45:3217-3226. [PMID: 26096463 DOI: 10.1017/s003329171500121x] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Glucocorticoids and serotonin may mediate the link between maternal environment, fetal brain development and 'programming' of offspring behaviors. The placenta regulates fetal exposure to maternal hormonal signals in animal studies, but few data address this in humans. We measured prospectively maternal depressive symptoms during pregnancy and mRNAs encoding key gene products determining glucocorticoid and serotonin function in term human placenta and explored associations with infant regulatory behaviors. METHOD Bi-weekly self-ratings of the Center for Epidemiologic Studies Depression Scale from 12th to 13th gestational week onwards and term placental mRNAs of 11beta-hydroxysteroid dehydrogenase type 2 (HSD2B11), type 1 (HSD1B11), glucocorticoid (NR3C1), mineralocorticoid receptors (NR3C2) and serotonin transporter (SLC6A4) were obtained from 54 healthy mothers aged 32.2 ± 5.3 years with singleton pregnancies and without pregnancy complications. Infant regulatory behaviors (crying, feeding, spitting, elimination, sleeping and predictability) were mother-rated at 15.6 ± 4.2 days. RESULTS Higher placental mRNA levels of HSD2B11 [0.41 standard deviation (s.d.) unit increase per s.d. unit increase; 95% confidence interval (CI) 0.13-0.69, p = 0.005], HSD1B11 (0.30, 0.03-0.57, p = 0.03), NR3C1 (0.44, 0.19-0.68, p = 0.001) and SLC6A4 (0.26, 0.00-0.53, p = 0.05) were associated with more regulatory behavioral challenges of the infant. Higher placental NR3C1 mRNA partly mediated the association between maternal depressive symptoms during pregnancy and infant regulatory behaviors (p < 0.05). CONCLUSIONS Higher placental expression of genes regulating feto-placental glucocorticoid and serotonin exposure is characteristic of infants with more regulatory behavioral challenges. Maternal depression acts, at least partly, via altering glucocorticoid action in the placenta to impact on offspring regulatory behaviors.
Collapse
Affiliation(s)
- K Räikkönen
- Institute of Behavioral Sciences,University of Helsinki,Helsinki,Finland
| | - A-K Pesonen
- Institute of Behavioral Sciences,University of Helsinki,Helsinki,Finland
| | - J R O'Reilly
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science,Queen's Medical Research Institute,Edinburgh,UK
| | - S Tuovinen
- Institute of Behavioral Sciences,University of Helsinki,Helsinki,Finland
| | - M Lahti
- Institute of Behavioral Sciences,University of Helsinki,Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,Helsinki,Finland
| | - P Villa
- Research Programmes Unit,Women's Health,University of Helsinki,Helsinki,Finland
| | - H Laivuori
- Haartman Institute,Medical Genetics,University of Helsinki,Helsinki,Finland
| | - E Hämäläinen
- HUSLAB and Department of Clinical Chemistry,Helsinki University Central Hospital, University of Helsinki,Helsinki,Finland
| | - J R Seckl
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science,Queen's Medical Research Institute,Edinburgh,UK
| | - R M Reynolds
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science,Queen's Medical Research Institute,Edinburgh,UK
| |
Collapse
|
49
|
Reynolds RM, Pesonen AK, O'Reilly JR, Tuovinen S, Lahti M, Kajantie E, Villa PM, Laivuori H, Hämäläinen E, Seckl JR, Räikkönen K. Maternal depressive symptoms throughout pregnancy are associated with increased placental glucocorticoid sensitivity. Psychol Med 2015; 45:2023-2030. [PMID: 25628053 DOI: 10.1017/s003329171400316x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Maternal prenatal depression predicts post-partum depression and increases risk of prematurity and low birth weight. These effects may be mediated by altered placental function. We hypothesized that placental function would be influenced by the gestational week of experiencing depressive symptoms and aimed to examine associations between maternal depressive symptoms during pregnancy and placental expression of genes involved in glucocorticoid and serotonin transfer between mother and fetus. METHOD We studied women participating in a prospective pregnancy cohort: the Prediction and Prevention of Preeclampsia (PREDO) Study, Helsinki, Finland. Maternal depressive symptoms were assessed at 2-week intervals throughout pregnancy in 56 healthy women with singleton, term pregnancies. Messenger ribonucleic acid (mRNA) levels of glucocorticoid (GR) and mineralocorticoid (MR) receptors and serotonin transporter (SLC6A4), 11β-hydroxysteroid dehydrogenase type 1 (HSD1) and 2 (HSD2) were quantified in placental biopsies. RESULTS In adjusted analyses women who reported higher depressive symptoms across the whole pregnancy had higher mRNA levels of GR [effect size 0.31 s.d. units, 95% confidence interval (CI) 0.01-0.60, p = 0.042] and MR (effect size 0.34 s.d. units, 95% CI 0.01-0.68, p = 0.047). These effects were significant for symptoms experienced in the third trimester of pregnancy for GR; findings for MR were also significant for symptoms experienced in the second trimester. GR and MR mRNA levels increased linearly by having the trimester-specific depressive symptoms scores 0, 1 or 2-3 times above the clinical cut-off for depression (p = 0.003, p = 0.049, respectively, and p = 0.004, p = 0.15 in adjusted analyses). CONCLUSIONS Our findings offer potential gestational-age-specific mechanisms linking maternal depressive symptoms during pregnancy via placental biology. Future studies will test whether these also link with adverse offspring outcomes.
Collapse
Affiliation(s)
- R M Reynolds
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - A-K Pesonen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - J R O'Reilly
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - S Tuovinen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - M Lahti
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,00271 Helsinki,Finland
| | - P M Villa
- Department of Obstetrics and Gynaecology,University of Helsinki and Helsinki University Central Hospital,Helsinki,Finland
| | - H Laivuori
- Haartman Institute, Medical Genetics, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| | - E Hämäläinen
- HUSLAB and Department of Clinical Chemistry,Helsinki University Central Hospital,00014 University of Helsinki,Helsinki,Finland
| | - J R Seckl
- Endocrinology Unit,University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute,47 Little France Crescent,Edinburgh,UK
| | - K Räikkönen
- Institute of Behavioral Sciences, University of Helsinki,00014 University of Helsinki,Helsinki,Finland
| |
Collapse
|
50
|
Lahti M, Eriksson JG, Heinonen K, Kajantie E, Lahti J, Wahlbeck K, Tuovinen S, Pesonen AK, Mikkonen M, Osmond C, Barker DJP, Räikkönen K. Late preterm birth, post-term birth, and abnormal fetal growth as risk factors for severe mental disorders from early to late adulthood. Psychol Med 2015; 45:985-999. [PMID: 25191989 DOI: 10.1017/s0033291714001998] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Late preterm births constitute the majority of preterm births. However, most evidence suggesting that preterm birth predicts the risk of mental disorders comes from studies on earlier preterm births. We examined if late preterm birth predicts the risks of severe mental disorders from early to late adulthood. We also studied whether adulthood mental disorders are associated with post-term birth or with being born small (SGA) or large (LGA) for gestational age, which have been previously associated with psychopathology risk in younger ages. METHOD Of 12 597 Helsinki Birth Cohort Study participants, born 1934-1944, 664 were born late preterm, 1221 post-term, 287 SGA, and 301 LGA. The diagnoses of mental disorders were identified from national hospital discharge and cause of death registers from 1969 to 2010. In total, 1660 (13.2%) participants had severe mental disorders. RESULTS Individuals born late preterm did not differ from term-born individuals in their risk of any severe mental disorder. However, men born late preterm had a significantly increased risk of suicide. Post-term birth predicted significantly increased risks of any mental disorder in general and particularly of substance use and anxiety disorders. Individuals born SGA had significantly increased risks of any mental and substance use disorders. Women born LGA had an increased risk of psychotic disorders. CONCLUSIONS Although men born late preterm had an increased suicide risk, late preterm birth did not exert widespread effects on adult psychopathology. In contrast, the risks of severe mental disorders across adulthood were increased among individuals born SGA and individuals born post-term.
Collapse
Affiliation(s)
- M Lahti
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - J G Eriksson
- National Institute for Health and Welfare,Helsinki,Finland
| | - K Heinonen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - E Kajantie
- National Institute for Health and Welfare,Helsinki,Finland
| | - J Lahti
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - K Wahlbeck
- National Institute for Health and Welfare,Helsinki,Finland
| | - S Tuovinen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - A-K Pesonen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| | - M Mikkonen
- National Institute for Health and Welfare,Helsinki,Finland
| | - C Osmond
- MRC Lifecourse Epidemiology Unit,University of Southampton,UK
| | | | - K Räikkönen
- Institute of Behavioural Sciences, University of Helsinki,Finland
| |
Collapse
|