Psychological consultation in older adult inpatient settings: A qualitative investigation of the impact on staff's daily practice and the mechanisms of change

The impact of sleep disorders (SDs) on patients with chronic liver diseases (CLD) is tremendous. SDs are frequently encountered among these patients and interfere with their quality of life. This review aims to present the data available so far about the prevalence, phenotypes, and proposed pathophysiological mechanisms of SDs in CLD. Moreover, we proposed to search the literature regarding the most reliable methods to assess SDs and the possible therapeutic options in patients with CLD. The main results of this review show that when it comes to prevalence, the percentages reported vary widely between studies performed among populations from the USA or Europe and those coming from Asian countries. Furthermore, it has been proven that SDs may also be present in the absence of neurocognitive disorders attributable to hepatic encephalopathy (HE), which contradicts traditional suppositions where SDs were considered part of the clinical scenario of HE. Currently, there are no specific recommendations or protocols to assess SDs in CLD patients and data about the therapeutic management are limited. Taking into consideration their impact, a protocol for diagnosing and managing SDs should be developed and included in the daily practice of hepatologists.

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Measuring capability wellbeing in adults at different stages of life for use in economic evaluation of health and care interventions: a qualitative investigation in people requiring kidney care

Quality of Life Research ◽

10.1007/s11136-021-02851-z ◽

2021 ◽

Author(s):

Paul Mark Mitchell ◽

Samantha Husbands ◽

Sabina Sanghera ◽

Fergus John Caskey ◽

Jemima Scott ◽

...

Keyword(s):

Life Stage ◽

Structured Interview ◽

Health Conditions ◽

Economic Evaluations ◽

Qualitative Investigation ◽

Key Factors ◽

Younger Adults ◽

Patient Groups ◽

The Life Course ◽

The Impact

Abstract Purpose Capability wellbeing measures, such as the ICECAP measures, have been proposed for use in economic evaluations to capture broader outcomes of health and care interventions. The ICECAP measures have been developed to reflect capabilities at different stages of life. Some patient groups include patients of different ages and at different stages of life, so it is not always apparent which ICECAP measure is most relevant. This study explores the impact of age and life stage on completion, where both ICECAP-A and ICECAP-O were completed by the same patient. Methods A think-aloud study, and an associated semi-structured interview were conducted with people receiving kidney care as a renal outpatient, kidney transplant outpatient, or through receiving facility-based haemodialysis. Qualitative analysis focused on (1) differences in responses across measures by individuals, where attributes had conceptual overlap, (2) key factors in self-reported capability levels, and (3) measure preference. Results Thirty participants were included in the study, with a mix of older and younger adults. Attributes with similar wording across measures produced similar responses compared to attributes where wording differed. Age and health were key factors for self-reported capability levels. ICECAP-A was slightly preferred overall, including by older adults. Conclusion This study suggests use of ICECAP-A in patients with certain chronic health conditions that include a mix of adults across the life course. This study highlights the importance of considering the stage of life when using capability measures and in economic evaluations of health and care interventions more generally.

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What is the impact of staff wearing uniforms in psychiatric inpatient settings?

Journal of Psychiatric Intensive Care ◽

10.20299/jpi.2021.006 ◽

2021 ◽

Author(s):

Sophie Collingwood ◽

Laura McKenzie-Smith

Keyword(s):

Mental Health ◽

Thematic Analysis ◽

Negative Impact ◽

Psychiatric Inpatient ◽

Ideal Self ◽

Search Terms ◽

Mental Health Settings ◽

Inpatient Settings ◽

The Impact

Background: Uniform has traditionally been worn in psychiatric inpatient and other mental health settings, but there has been a move to non-uniform in recent years. Some services have made the change back to uniform, raising questionsabout the potential impact on patients and staff.Aim: To review the impact of uniform within a psychiatric inpatient or mental health setting.Method: Databases were searched for articles exploring the impact of uniform use using specified search terms. Articles were assessed for suitability with inclusion and exclusion criteria, critically appraised, then analysed for themes using thematic analysis.Results: 17 papers were included in the review. Thematic analysis identified five main themes and 29 subthemes. Main themes were Attitudes and interactions, A freer environment, Are you both nurses?, The ‘ideal self’ and There are more important things. A critical appraisal of the articles suggested issues with validityand reliability, which are discussed.Discussion: Studies identified that wearing non-uniform facilitated positive changes in both patients and staff. This raises the potential negative impact of uniform on both patients and staff, and the role of power imbalance in these settings is discussed. Further themes around identification of staff out of uniform were considered.Implications for practice: The use of uniform in mental health and psychiatric inpatient settings should be considered carefully, due to the potential negative impact, whilst also recognising the importance of staff identification and supporting professional identity.

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Enhancing the therapeutic interaction skills of staff working in acute adult inpatient psychiatric wards: Outcomes of a brief intervention education programme

Journal of Nursing Education and Practice ◽

10.5430/jnep.v7n11p123 ◽

2017 ◽

Vol 7 (11) ◽

pp. 123 ◽

Cited By ~ 2

Author(s):

Mary Chambers ◽

Xenya Kantaris

Keyword(s):

Service User ◽

Daily Practice ◽

Education And Training ◽

Service Users ◽

Personal Learning ◽

Therapeutic Interaction ◽

Managerial Support ◽

Short Course ◽

Adult Inpatient ◽

And Training

Background and objective: Clinical practice in acute inpatient environments is complex and demanding for clinical staff. To facilitate service user recovery, it is essential that personnel working in these environments are competent and confident in a range of therapeutic interaction skills, which can have impact in a brief period. This paper describes an exploratory study which determined the outcomes of a brief therapeutic engagement education and training short course for staff working in adult inpatient acute wards. As far as we know this was the first time, based on evidence from earlier research involving service users that Heron’s Six Category Intervention Analysis and solution focused brief therapy (SFBT) have been combined in an education and training short course that was coproduced and delivered in partnership with service users for staff working in acute environments.Methods: The short course explored the myriad applications of the six categories of intervention initially proposed by Heron and the widespread applicability of SFBT. The programme evaluation adopted focus group methodology and examined: (1) how useful the training content was to daily practice and how relevant the skills learn were to interactions with service user residing on the ward; (2) the factors than helped enable the transference of the learning to the ward environment as well as any barriers; (3) personal learning; and (4) strengths of the learning experience and suggestions for improvement to the training and learning experience.Results: Feedback from participants reflected a high degree of skill and knowledge acquisition and enhancement. Staff found the content of the training useful and helpful to their daily practice as it aided in increasing confidence, therapeutic interventions and care-planning. Skills learnt by the trainees were considered relevant to interactions with service users residing on the ward. Factors that helped to enable encounters with service users, as well as the barriers, when transferring the learning to the ward environment were discussed and included managerial support, demand for beds, time, opportunity and staffing shortages. Regarding personal learning, staff reported feeling more able to connect with service users when employing SFBT techniques and Heron’s intervention approaches and felt that the training validated their current working practice.Conclusions: The SFBT training appears to have provided an interactional communication toolkit for healthcare professionals and could be further embraced given the right circumstances e.g. managerial support and attitude change of nursing staff in general. Further research is needed to gain an understanding of the effect of short and concentrated education and training programmes aimed at staff members working within adult acute inpatient mental healthcare settings, as well as measuring whether the activity, i.e. healthcare professional–service user interactions, is meaningful to service user outcomes.

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Student Perceptions and Understanding of Client-Therapist Interactions Within the Inpatient Acute Care Environment: Qualitative Study

Physical Therapy ◽

10.2522/ptj.20140207 ◽

2015 ◽

Vol 95 (2) ◽

pp. 235-248 ◽

Cited By ~ 3

Author(s):

Lorna M. Hayward ◽

Kristin C. Greenwood ◽

Matthew Nippins ◽

Alicia Canali

Keyword(s):

Student Perceptions ◽

Acute Care ◽

Professional Competence ◽

Physical Therapists ◽

Sampling Technique ◽

The United States ◽

Doctor Of Physical Therapy ◽

Inpatient Settings ◽

Acute Care Settings ◽

The Impact

BackgroundPhysical therapists practicing in inpatient acute care settings in the United States work in a 21st century health care system that requires professional competence in clinical reasoning and decision making. For doctor of physical therapy (DPT) students, the development of confidence in the patient evaluation and the professional skills necessary for managing the inpatient environment can be challenging.ObjectiveThe study's purpose was to understand whether the early exposure of students to inpatient settings informed their understanding of the thought processes and actions of experienced clinicians during client interactions.DesignA qualitative design was used.MethodsThirty-three DPT students working in inpatient settings were recruited from 15 unique inpatient hospital (acute care and rehabilitation) facilities with a convenience sampling technique. Reflective data were collected for 1 month with clinician-facilitated discussion boards.ResultsFour themes emerged: environment, communication, evaluation, and client-therapist interaction. The themes informed a conceptual model depicting the observation by DPT students of factors that influenced interactions between clients and experienced clinicians in inpatient settings. Reflection on the what, the how, and the why that informed clinical decisions enabled students to recognize the situated nature of evaluation and treatment approaches.LimitationsThe use of a sample from 1 year of a DPT program at one university reduced the generalizability of the results.ConclusionsLimited research has examined student perceptions of the interactions of experienced clinicians with clients in inpatient acute care settings. More research is needed to understand the impact of exposing students to the thoughts and actions of therapists working in such settings earlier within DPT curricula.

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Is Overtourism Overused? Understanding the Impact of Tourism in a City Context

Sustainability ◽

10.3390/su10124384 ◽

2018 ◽

Vol 10 (12) ◽

pp. 4384 ◽

Cited By ~ 145

Author(s):

Ko Koens ◽

Albert Postma ◽

Bernadett Papp

Keyword(s):

Historical Context ◽

Popular Media ◽

Current Paper ◽

Qualitative Investigation ◽

Tourism Impacts ◽

European Cities ◽

To Come ◽

The Impact

In less than two years, the concept of overtourism has come to prominence as one of the most discussed issues with regards to tourism in popular media and, increasingly, academia. In spite of its popularity, the term is still not clearly delineated and remains open to multiple interpretations. The current paper aims to provide more clarity with regard to what overtourism entails by placing the concept in a historical context and presenting results from a qualitative investigation among 80 stakeholders in 13 European cities. Results highlight that overtourism describes an issue that is multidimensional and complex. Not only are the issues caused by tourism and nontourism stakeholders, but they should also be viewed in the context of wider societal and city developments. The article concludes by arguing that while the debate on overtourism has drawn attention again to the old problem of managing negative tourism impacts, it is not well conceptualized. Seven overtourism myths are identified that may inhibit a well-rounded understanding of the concept. To further a contextualized understanding of overtourism, the paper calls for researchers from other disciplines to engage with the topic to come to new insights.

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Magnetic Resonance-Compatible Arm-Crank Ergometry: A New Platform Linking Whole-Body Calorimetry to Upper-Extremity Biomechanics and Arm Muscle Metabolism

10.21203/rs.3.rs-37885/v1 ◽

2020 ◽

Author(s):

Riemer JK Vegter ◽

Sebastiaan van den Brink ◽

Leonora J Mouton ◽

Anita Sibeijn-Kuiper ◽

Lucas H.V. van der Woude ◽

...

Keyword(s):

Magnetic Resonance ◽

Surface Electromyography ◽

Motor Units ◽

Daily Practice ◽

Muscle Disease ◽

Upper Body ◽

Whole Body ◽

Energetic Efficiency ◽

The Impact

Abstract Background: Evaluation of the effect of human upper body training regimens may benefit from knowledge of local energy expenditure in arm muscles. To that end, we developed a novel asynchronous arm-crank ergometry platform for use in a clinical magnetic resonance (MR) scanner with 31P spectroscopy capability to study arm muscle energetics. The utility of the platform was tested in an investigation of the impact of daily practice on the energetic efficiency of execution of an arm-cranking task (ACT) in healthy subjects. Results: We recorded the first ever in vivo 31P MR spectra from the human biceps bracii muscle during ACT execution pre- and post-three weeks of daily practice bouts, respectively. Complementary datasets on whole body oxygen consumption, arm muscle electrical activity, arm-force and power output, respectively, were obtained in the mock-up scanner. The mean gross mechanical efficiency of execution of the ACT significantly increased 1.5-fold from 5.7 ± 1.2% to 8.6 ± 1.7% (P<0.05) after training, respectively. However, in only one subject this improvement was associated with recruitment of strictly oxidative motor units in the working biceps muscle. In all other subjects, biceps pH fell below 6.8 during exercise indicating recruitment of anaerobic motor units, the magnitude of which was either unaffected (two subjects) or even increased (two subjects) post-training. Surface electromyography and mechanical force recordings revealed that individuals employed various arm muscle recruitment strategies, using either predominantly elbow flexor muscles (two subjects), elbow extensor muscles (one subject,) or a combination of the two (two subjects), respectively. Three weeks of training improved muscle coordination but did not alter individual strategies. Conclusions: The new platform has produced the first ever in vivo dynamic data on human biceps energy and pH balance during upper body exercise. It allows evaluation of cyclic motor performance and outcomes of upper-body training regimens in healthy novices by integrating these new measurements with whole body calorimetry, surface electromyography and biomechanical measurements. This methodology may be equally valid for lower-limb impaired athletes, wheelchair users and patients with debilitating muscle disease.

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Identification of the Medication Regimen Complexity Index as an Associated Factor of Nonadherence to Antiretroviral Treatment in HIV Positive Patients

Annals of Pharmacotherapy ◽

10.1177/1060028018766908 ◽

2018 ◽

Vol 52 (9) ◽

pp. 862-867 ◽

Cited By ~ 4

Author(s):

Mercedes Manzano-García ◽

Concepción Pérez-Guerrero ◽

Maria Álvarez de Sotomayor Paz ◽

Mª de las Aguas Robustillo-Cortés ◽

Carmen Victoria Almeida-González ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Treatment ◽

Daily Practice ◽

Concomitant Treatment ◽

Medication Regimen ◽

Associated Factor ◽

Medication Regimen Complexity ◽

Complexity Index ◽

Regimen Complexity ◽

The Impact

Background: Multiple studies have identified a relationship between the complexity of a medication regimen and non-adherence. However, most studies in people who live with HIV (PLWH) have focused on antiretroviral use and have failed to consider the impact of other medications. Objective: The aim of our study is to identify the Medication Regimen Complexity Index (MRCI) as an associated factor for nonadherence to antiretroviral treatment (ART). The secondary aim is to analyze the relationship between clinical and pharmacotherapeutical variables and adherence to antiretroviral treatment and to generate an adherence model. Methods: A transversal, observational study. Patients included were PLWH over 18 years of age on active antiretroviral therapy. Patients who participated in clinical trials or who did not meet the inclusion criteria were excluded. We had studied HIV transmission mode, viral load, treatment status, number of comorbidities and complexity index as factors associated with adherence to ART. Results: We included 619 patients in the study. Number of comorbidities ( p = 0.021; OR = 1.038-1.570); viral load ( p = 0.023; OR = 1.108-4.505) and MRCI ( p < 0.001; OR = 1.138-1.262) (ART and concomitant treatment) were the independent associated factors to ART nonadherence. The value of the Hosmer and Lemeshow test confirmed the validity of this model (P = 0.333). Conclusion: A higher MRCI was associated with non-adherence. Therefore, the regimen complexity calculation may be appropriate in daily practice for identifying patients at a higher risk of becoming non-adherent.

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