scholarly journals Facing a blind alley - Experiences of stress-related exhaustion: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038230
Author(s):  
Sara Alsén ◽  
Lilas Ali ◽  
Inger Ekman ◽  
Andreas Fors
Keyword(s):  
Mental Illness ◽  
Qualitative Study ◽  
Sick Leave ◽  
Personal Identity ◽  
Healthcare Professionals ◽  
Careful Consideration ◽  
Blind Alley ◽  
Existential Issues ◽  
Frequent Reason ◽  
Improve Health

IntroductionMental illness is a major concern in many countries. In Sweden, stress-related mental illness is currently the most frequent reason for sick leave.ObjectiveThis study aimed to explore patients’ experiences of stress-related exhaustion.DesignA qualitative study with interview data analysed using a phenomenological hermeneutic method.SettingParticipants were selected from public primary healthcare centres in a larger city in western Sweden.ParticipantsSeven women and five men on sick leave from work due to stress-related exhaustion were included in the study.FindingsStress-related exhaustion was experienced as a loss of access to oneself and one’s context and feelings of being trapped and lost in life. The condition had a significant impact on personal identity, raised existential issues and was interpreted as facing a blind alley. Participants described a mistaken direction in life, being forced to stop, change direction and act differently.ConclusionStress-related exhaustion is a challenging, life-changing existential experience that involves a crisis with an opportunity for new insights. Careful consideration of patients’ narratives together with the expertise of healthcare professionals can be combined to improve health and optimise recovery based on individual’s situation.

scholarly journals Recognition and response to life-threatening situations among women with perinatal mental illness: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025872 ◽  
Author(s):  
Abigail Easter ◽  
Louise Michelle Howard ◽  
Jane Sandall
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Qualitative Study ◽  
Service Provision ◽  
Healthcare Professionals ◽  
Perinatal Period ◽  
Professional Culture ◽  
Near Miss ◽  
Prescribe Medication ◽  
Life Threatening

ObjectiveMental illness has persistently been found to be a leading cause of death during pregnancy and the year after birth (the perinatal period). This study aims to explore barriers to detection, response and escalation of mental health-related life-threatening near miss events among women with perinatal mental illness.DesignQualitative study.ParticipantsHealthcare professionals (HCP) working in psychiatry, maternity and primary care (n=15) across community and hospital maternity and perinatal services within the UK.MethodsIn-depth semistructured interviews were conducted with a range of healthcare professionals working with women during the perinatal period. An iterative process of inductive and deductive thematic analysis, informed by systems theories of healthcare and the Three Delays model, was employed to analyse the data.ResultsThree overarching themes were identified: recognition of severity, communication of risk and service provision and access to treatment. Differing perspectives of mental illness severity influenced how life-threatening situations among women with perinatal mental illness were described, recognised and communicated between teams. Under-resourced mental health service provision, particularly within emergency and specialist perinatal mental health services, unclear thresholds for escalating care and poor infrastructure for sharing information all contributed to delays in a timely response to crisis situations. Reluctance to prescribe medication or admit women to psychiatric hospital, stigma and missed appointments created further delays.ConclusionsResponse and escalation of care for life threatening near miss events among women with mental illness is strongly influenced by professional culture and understandings of mental illness embedded within different healthcare disciplines. Focusing on how differences in organisational and professional culture contribute to the recognition of severe mental illness and interdisciplinary communication may help facilitate clearer co-ordination between teams.

scholarly journals Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals’ perspectives

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042497
Author(s):  
Annabel Nash ◽  
Tom Kingstone ◽  
Saeed Farooq ◽  
Jessica Tunmore ◽  
Carolyn A Chew-Graham
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Illness ◽  
Side Effects ◽  
Qualitative Study ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Mental Health Nurses

ObjectivesThe side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI).DesignA qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants’ views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison.SettingsParticipants recruited through primary care and one mental health trust in the West Midlands.ParticipantsInterviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.ResultsAwareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this.ConclusionsThis study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

scholarly journals Patients’ and healthcare professionals’ beliefs, perceptions and needs towards chronic kidney disease self-management in China: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044059
Author(s):  
Hongxia Shen ◽  
Rianne M J J van der Kleij ◽  
Paul J M van der Boog ◽  
Wenjiao Wang ◽  
Xiaoyue Song ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Illness Perceptions ◽  
Chinese Patients ◽  
Self Management ◽  
Tertiary Referral Hospital ◽  
Chinese Context ◽  
Management Interventions

ObjectivesTo support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management.DesignA basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations.SettingOne major tertiary referral hospital in Henan province, China.Participants11 adults with a diagnosis of CKD with CKD stages G1–G5 and 10 HCPs who worked in the Department of Nephrology.ResultsFour themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient–HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources.ConclusionsThe limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient–HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.

scholarly journals Understanding health-seeking and adherence to treatment by patients with esophageal cancer at the Uganda cancer Institute: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nakimuli Esther ◽  
Ssentongo Julius ◽  
Mwaka Amos Deogratius
Keyword(s):  
Esophageal Cancer ◽  
Data Collection ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Healthcare Professionals ◽  
Transport Cost ◽  
Adherence To Treatment ◽  
Health Seeking ◽  
Long Distance ◽  
Cancer Symptoms

Abstract Background In the low- and middle-income countries, most patients with esophageal cancer present with advanced stage disease and experience poor survival. There is inadequate understanding of the factors that influence decisions to and actual health-seeking, and adherence to treatment regimens among esophageal cancer patients in Uganda, yet this knowledge is critical in informing interventions to promote prompt health-seeking, diagnosis at early stage and access to appropriate cancer therapy to improve survival. We explored health-seeking experiences and adherence to treatment among esophageal cancer patients attending the Uganda Cancer Institute. Methods We conducted an interview based qualitative study at the Uganda Cancer Institute (UCI). Participants included patients with established histology diagnosis of esophageal cancer and healthcare professionals involved in the care of these patients. We used purposive sampling approach to select study participants. In-depth and key informant interviews were used in data collection. Data collection was conducted till point of data saturation was reached. Thematic content analysis approach was used in data analyses and interpretations. Themes and subthemes were identified deductively. Results Sixteen patients and 17 healthcare professionals were included in the study. Delayed health-seeking and poor adherence to treatment were related to (i) emotional and psychosocial factors including stress of cancer diagnosis, stigma related to esophageal cancer symptoms, and fear of loss of jobs and livelihood, (ii) limited knowledge and recognition of esophageal cancer symptoms by both patients and primary healthcare professionals, and (iii) limited access to specialized cancer care, mainly because of long distance to the facility and associated high transport cost. Patients were generally enthused with patient – provider relationships at the UCI. While inadequate communication and some degree of incivility were reported, majority of patients thought the healthcare professionals were empathetic and supportive. Conclusion Health system and individual patient factors influence health-seeking for symptoms of esophageal cancer and adherence to treatment schedule for the disease. Interventions to improve access to and acceptability of esophageal cancer services, as well as increase public awareness of esophageal cancer risk factors and symptoms could lead to earlier diagnosis and potentially better survival from the disease in Uganda.

scholarly journals Ethical challenges of caring for burn patients: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mostafa Bijani ◽  
Fateme Mohammadi
Keyword(s):  
Qualitative Study ◽  
Personal Identity ◽  
Clinical Decision ◽  
Vulnerable Groups ◽  
Burn Patients ◽  
Ethical Challenges ◽  
Data Saturation ◽  
Field Notes ◽  
Improved Performance ◽  
Colaizzi's Method

Abstract Background Burn patients are among the most vulnerable groups of patients requiring principled ethical care. Caring for these patients often brings various ethical challenges for the members of the health care teams, especially nurses, which affect the clinical decisions made for these patients. A limited number of studies have addressed the ethical challenges of caring for burn patients for the responsible caregivers, so the present study attempted to identify these challenges. The present study aimed to explore the health professionals' experiences of the ethical challenges during caring for burn patients. Methods This was a qualitative study with a descriptive, phenomenological design. 22 health professional practiced in public burn centers in Iran who met the inclusion criteria of the study were selected via purposeful sampling to participate in the study from June to August 2019. Data were collected using semi-structured, in-depth interviews with the individuals as well as field notes. Sampling was continued up to the data saturation. Thereafter, the collected data were analyzed using Colaizzi's method. Results The findings of the study yielded 3 themes, including respect for the patient's privacy, respect for the patient's personal identity, and care challenges, as well as 9 categories. Conclusion The findings of this study showed that the burn patients’ caregivers face some challenges in the domains of maintaining the patient's privacy, respecting the patient’s personal identity, and making the best clinical decision. Thus, providing the cultural, professional, and organizational requirements of meeting the challenges of caring for burn patients can consequently result in the caregivers’ inner peace and the improved performance.

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