Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives

This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.

Additional Evidence for Neuropsychiatric Manifestations in Mosaic Trisomy 20: A Case Report and Brief Review

Mosaic trisomy 20 is a genetic condition in which three chromosomes 20 are found in some cells. Its clinical phenotype seems to be highly variable, with most features not reported across all individuals and not considered pathognomonic of the condition. Limited and recent evidence indicates that neuropsychiatric manifestations may be more present in the context of trisomy 20 than was once thought. Here, we present a case of a 14-year-old female adolescent of White/Caucasian ethnicity with mosaic trisomy 20, who was admitted twice to an inpatient Child and Adolescent Neuropsychiatry Unit for persisting self-injury and suicidal ideation. A severe and complex neuropsychiatric presentation emerged at the cognitive, emotional, and behavioral levels, including mild neurodevelopmental issues, isolation, socio-relational difficulties, depressed mood, temper outbursts, irritability, low self-esteem, lack of interest, social anxiety, panic attacks, self-cutting, and low-average-range and heterogeneous intelligence quotient profile. Particularly, the patient was considered at high risk of causing harm, mainly to self, and appeared to be only partially responsive to medication, even when polypharmacy was attempted to improve clinical response. Except for school bullying, no other severe environmental risk factors were present in the patient’s history. The patient received a diagnosis of disruptive mood dysregulation disorder.

From Swallowing to Savoring Emotions

This article presents a Therapeutic Assessment case study of a 48-year-old Catholic nun who was evaluated for concerns related to recurrent depression, difficulty relating to others, trouble following through on tasks, and lack of self-care. Maria was given the Rorschach, MMPI-2-RF, Wartegg Drawing Completion Test, and Thurston Cradock Test of Shame (TCTS). Testing results suggested depression, problems regulating emotion, incongruence between external presentation and internal state, and impaired functional intelligence when negative emotions are triggered. Maria’s TCTS protocol indicated a tendency to deflate in the presence of shame or criticism. She used tentative language around emotion, did not access support, and struggled to resolve emotionally charged situations. The TCTS results appeared to access and explain Maria’s core difficulties. TCTS Cards 6 and 8 were selected for an assessment intervention session (AIS) designed to help Maria understand what she does with negative feelings. Maria was asked to tell a story focusing on the main character. Through half-steps and affective scaffolding, Maria identified how she “swallows” her negative feelings and “isolates” when emotions are strong. The authors discuss how the AIS helped Maria access her split-off affect, and understand its relation to her symptoms, poor self-care, impaired follow-through, and relational difficulties.

Music therapy with couples and families in the United Kingdom: a review

A review of UK sources relating to the use of music therapy in work with couples and families revealed reports on family work with pre-school children in the context of a child development centre, with vulnerable young children in a child and family psychiatric unit, and with adolescents and their carers in clinical settings. There are no reports of music therapy being used in helping couples struggling with relational difficulties, or with managing their special needs children. There is also no mention of therapeutic help being extended to strengthening co-parenting with behaviourally challenging children. Music therapists do not appear to regard couple work as being distinct from family work and this could explain the scarcity of literature relating specifically to couples. It may also be that by limiting the definition of music therapy to rehabilitative work following physical injury the British Association of Music Therapy (BAMT) has limited publications on couple and family work in the UK.

Training NHS staff to work with people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI)/borderline personality disorder

Purpose Improvement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training. Design/methodology/approach A mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package. Findings Statistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training. Research limitations/implications This was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation. Practical implications Given the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training. Originality/value Positive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.

Perception of health professionals about neonatal palliative care

ABSTRACT Objective: To identify the perception of health professionals about neonatal palliative care. Method: A phenomenological qualitative study, a non-probabilistic sample, of 15 health professionals from a neonatal intensive care unit in northern Portugal. Content analysis was performed. Results: Despite their lack of training in palliative care, the health professionals showed concern for the dignity, quality of life and comfort of the newborn and family. They expressed emotional and relational difficulties in following the trajectories of serious illness and death and in the ethical decisions regarding the end-of-life. Conclusion: It is emphasized that professionals are sensitive to pain and suffering and reveal dedicated and committed in the care of the newborn and family. They are available to train and embrace the current challenges posed by the constitution of pediatric palliative care teams and to help achieve an organizational culture that advances in such care.

Incarcerated for a Sex Offense: In-Prison Experiences and Concerns about Reentry

Using a sample of 3,041 incarcerated men and women, this study examines the impact of being incarcerated for a sex offense and individuals’ in-prison experiences on their concerns about reentry into society. Bivariate analyses suggest that being incarcerated for a sex offense is related to greater concerns about housing and fewer concerns about recidivism compared with individuals incarcerated for nonsex offenses. A sex offense conviction is also associated with weaker social bonds, greater relational difficulties, and greater fear of victimization while incarcerated. Multiple regression models indicate that, after controlling for in-prison experiences, being incarcerated for a sex offense increases reentry concerns related to employment and housing, though may reduce them for recidivism. In-prison experiences mediate the relationship between being incarcerated for a sex offense and reentry concerns. Policy implications of these findings are discussed.

The Question Teacher and the Case for a Therapeutic Turn Within Teacher Education

Reflexivity figures increasingly in teacher education, and different reflexive turns have produced a range of directions for thinking about teachers and teaching. This article problematizes some reflexive practices, including self-study and teacher renewal, as a means of contextualizing a call for the inclusion of a therapeutic reflexivity aimed at the “question teacher.” Derived from the psychoanalytic and psychotherapeutic subject, this “question teacher” is vulnerable and motivated by forces not entirely conscious or rational. It is argued that a psychotherapeutic pedagogy enables teachers to address their existential and relational difficulties and contributes to a teacher education that sees teacher identity and practice as highly relational and situated. Examples of a fully committed therapeutic reflexivity are given, alongside some research results of their transformational potential. It is proposed that the generation of empirical evidence for the efficacy of therapeutic reflexivity will permit its advocates to answer critics and overcome a systemic resistance.

Cognitive analytic team formulation: learning and challenges for multidisciplinary inpatient staff

Purpose The purpose of this paper is to understand staff experiences of cognitive analytic team formulation, within an inpatient unit for women with a diagnosis of personality disorder. Design/methodology/approach In total, 16 staff completed an online questionnaire, rating their views on how helpful formulation sessions had been in regards to ten domains. Following this, six staff participated in semi-structured interviews exploring their experiences of the process and impact of cognitive analytic team formulation. Transcripts were analysed using thematic analysis. Findings Responses from questionnaires indicated the general process of team formulation was helpful across each domain. Interviews highlighted benefits such as an increased capacity to think and work relationally. This was impacted upon by staff’s confidence in using the model and the practicalities of attending sessions. Practical implications Team formulation has been described as the facilitation of a group of professionals to create a shared understanding of service-users’ difficulties. Team formulation continues to demonstrate benefits for staff working within complex mental health. The challenges of this are considered, however overall, a cognitive analytic framework seems to offer staff the opportunity to integrate learning from a service-user’s history, and current relational difficulties, in a way that develops reflective capacity and informs intervention. Originality/value Limited research has explored the theoretical models underpinning team formulation, and the impact for staff learning and practice. The current study develops previous work by specifically focussing on the contribution of cognitive analytic theory to team formulation.

Companion Bills and Cross-Chamber Collaboration in the U.S. Congress

The U.S. House and Senate were designed to have an adversarial relationship. Yet, House members and senators often collaborate on the introduction of “companion” bills. We develop a theory of these cross-chamber collaborations, which asserts that companion bill introductions are driven by legislators’ desire to increase the probability of bill passage and the relational difficulties in developing companion bill partnerships. To test the expectations emerging from our theory, we develop a novel data set of every companion bill introduction in the 111th and 112th U.S. Congress. Then, using social networking techniques, we develop an empirical model of partner selection in companion bill introduction. Our results are supportive of our expectations, and suggest that companion bills are more likely to survive chamber deliberation and are typically introduced by senior members with secure electoral margins.