Abstract Introduction Despite its high prevalence and negative impact, mental illness is often sub‐optimally treated, in part, due to stigma among health care professionals. Future health care professionals are at the forefront of a potential solution for the provision of stigma‐free, equitable mental health care. Innovative approaches to reducing the stigma toward individuals with mental illness are needed. One approach is utilization of the SNAP the Stigma website ( www.snapthestigma.com ), a collection of photos and reflections by individuals with lived experiences with mental illness. Objective This study was conducted to address the question: Does interacting with the SNAP the Stigma website impact pharmacy and nursing students' perceptions and social distance preference toward an individual with mental illness? Methods A pre‐ and post‐survey employed the Bogardus social distance scale (SDS) to assess stigma toward a vignette individual before and after website interaction. In the post‐survey, participants reflected on one or more posts from the website that impacted them. A qualitative analysis was performed to identify themes from the responses. Results A statistically significant reduction in total SDS scores occurred as a result of interaction with SNAP. Three themes were derived including symbolism of mental illness, increased empathy/reduced stereotyping, and lessons regarding what a health care professional can do and offer. Conclusion These findings suggest that use of the SNAP website as a stigma‐reduction intervention could be a valuable tool for current and future health care professionals to decrease stigma toward those with mental illness and to build intentionality toward empathic and non‐discriminatory behavior in health care practice.
Factors contributing to the high rate of HCV chronicity are not fully understood. Interleukin 2(IL-2) is critical for the generation of broad-range antigen-specific host T-cell responses, essential for HCV clearance. Many viruses target IL-2 as part of their immune-evasion strategy, however, specific inhibition of IL-2 by HCV has not been demonstrated. CD81, a widely expressed tetraspanin, binds HCV envelope and inhibits NK cells, but, also acts as a co-stimulatory signal for IL-2 production by T cells. Thus, CD81:HCV interactions appear to favour the host and their role in viral persistence is paradoxical. We aimed to determine the role of IL-2 in HCV chronicity. We show that pre-engagement of CD81, using recombinant HCV-envelope or anti-CD81 antibodies, in a manner that mimics in vivo infection, inhibits IL-2 production by T cells. In addition HCV infectious serum produces the same inhibitory effect. We also demonstrate that hepatic IL-2 is significantly reduced in HCV compared to cirrhotic controls. These data support our model of HCV persistence whereby, CD81:HCV engagement prior to T-cell activation compromises host T cell responses. We describe a novel immune evasion strategy employed by HCV. Low-dose IL-2 in combination with current treatment regimes may lead to successful elimination of HCV.
The literature relating to health professionals and illicit drugs and clients who use them shows many common themes. It is evident that the majority of health professionals hold negative, stereotypical perceptions of illicit drug‐users. Consequently, these negative attitudes become prejudicial, hence blocking the professional from carrying out effective and humane nursing care to this client group. Evidence also shows that health professionals' perceptions on the legalization of currently illicit drugs is linked to their own use of these drugs rather than any social or health reasons. Professionals' views on the different illicit substances are also coloured by their use, not by the actual evidence relating to the effects of that drug, in particular, cannabis. The literature shows that health professionals project heavily on to the client all their own negative perceptions of illicit drug use, in the care setting. This has produced very unsatisfactory and unsafe care, resulting in both client and carer being dissatisfied with the whole aspect of care. In addition, specialist teams are being swamped by health professionals who are referring almost every illicit drug‐user to these services. The future may be brighter with the generalist and specialist working closely together for the benefit of all, especially the client and, ultimately, the community.
Since the early 1990s, clinical supervision has been the subject of debate by nurse academics and practitioners. This debate has encouraged the adoption of clinical supervision by the profession throughout the United Kingdom. Search of the literature demonstrates that there has been little published research regarding clinical supervision in Northern Ireland. This study is designed to redress this information deficit. The current position of clinical supervision in relation to community psychiatric nursing in Northern Ireland is explored and evaluated. A survey approach was adopted, collecting data from community psychiatric nurses (CPNs) in Health and Social Services Trusts in Northern Ireland. Data was obtained relating to the practice of clinical supervision and to attitudes of CPNs, their managers and supervisors. Results indicate that there is support for clinical supervision and that it is being implemented within community psychiatric nursing in Northern Ireland, although not in all cases. However, the findings indicate that serious education and training deficits exist, and the importance of the interface between managerial and clinical supervision is emphasized. The issues of providing effective education and training in supervision skills, and the uncertainty that was highlighted regarding fundamental concepts underpinning clinical supervision, have implications for nursing practice, education and management. In addition, based on findings of this study, the difference between management-led supervision and clinical supervision as envisaged by the UKCC, which promotes the personal and professional development of nurses, requires further exploration.
This quantitative and qualitative longitudinal study was designed to examine the effects on caregivers working therapeutically with seriously traumatized people. The participants were 13 healthcare workers seconded into a trauma and recovery team (TRT) set up to help those traumatized by the Omagh bombing on 15 August 1998. Quantitative data were collected using the Compassion Satisfaction/Fatigue Test and the Life Status Review Questionnaire. Qualitative data regarding positive and negative aspects of working with traumatized individuals, as well as caregiver's experience leaving the TRT, were gathered using open-ended questions contained in the final data set. These questionnaires were completed at four points in time: August 1998, December 1998, August 1999 and February 2001. Ethical approval for the study was gained from the Sperrin Lakeland Trust research committee. Analysis of the quantitative data indicated that levels of compassion fatigue and burnout increased, respectively, from 18.85 to 34.46 and 22.38 to 29.69 over the first year. Levels of compassion satisfaction decreased from 87.62 to 80.15, while levels of satisfaction with life (53.85 to 40.38) and life status (11.23 to 5.62) also decreased. Findings also demonstrated that compassion satisfaction is possibly a protective factor against compassion fatigue and burnout, in that caregivers with high compassion satisfaction scores were less likely to have corresponding high compassion fatigue and burnout scores. Findings from the qualitative data generated, revealed that team spirit and camaraderie, along with the satisfaction of seeing clients recover, were the most positive aspects of working in the team. Media interest, coping with and containing anger shown by bereaved relatives and dealing with the content of client's stories were the most negative. Themes to emerge from leaving the team included lack of understanding and support from non-trauma managers and an underestimation of the impact on caregivers of finishing in the team. Strategies that were found to be beneficial in helping to alleviate the negative effects of working with trauma were also elicited. This research has implications for practice, management and education.
This paper presents a theory of connectivity, which was formulated from the findings of a Classical Grounded Theory study that was designed to capture a sample of people's perceptions of living with depression or caring for individuals with depression. Data were collected from: (1) a focus group consisting of people with depression (n = 7), of which five were patients in the community and two were nurses; (2) one-to-one interviews with patients in the community (n = 5) and nurses (n = 5), three of whom had experienced depression from both sides of the caring process; and (3) two 'happy accident' focus groups (n = 25; n = 18) comprising of healthcare workers with a shared understanding of depression. Purposeful sampling was used initially. Thereafter, in keeping with one of the key tenets of grounded theory, theoretical sampling was used until theoretical saturation occurred. Data were analysed using the constant comparative approach together with the NVivo qualitative analysis software package. The core category that emerged was 'connectivity' relating to the connections and disconnections, which people make in their lives. Six key categories emerged all of which were integrated with the core category. Hence, connectivity provided a significant platform for understanding and responding to the life experience of depression. They were: (1) life encounters on the journey to naming; (2) depression: What's in a name? The silent thief; (3) tentative steps to health care; (4) connective encounters and challenges; (5) connecting with self; and (6) self-connection maintenance. Subsequently, a theory, 'Depression: a psychiatric nursing theory of connectivity', surfaced from the overall findings. We argue that this theory of connectivity provides a framework that people working in the field of holistic treatment and care could use to better understand and respond to the life experience of people living with depression.
Suicidal patients admitted to hospital following a suicidal attempt or expressing suicidal ideation present a real challenge to health professionals with regard to their therapeutic care. This study was undertaken to explore the attitudes of psychiatric nurses caring for such patients. Results reveal that psychiatric nurses do hold positive views on caring for potentially suicidal patients, contradicting previous studies where more negative feeling were expressed by nurses, especially those with initial contact. Findings also show that some nurses experience an element of distress, and the length of experience within such a working environment does not affect the nurses' level of satisfaction gained on caring for the suicidal patient. This study also identifies an expression of need for further education and practice in interpersonal skills and therapeutic modalities to enhance and develop a more effective delivery of care for this group of patients.
There is a lack of nursing research in relation to how people with mental health problems make sense of their experiences of mental distress. Furthermore, few nursing related studies have conveyed service user's understandings and meanings for their experiences of mental ‘disorder’. Narrative psychology claims that people make sense of the world and their lives by using narrative structures to organize diverse experiences. By sharing these stories with others, interpretations are negotiated and personal and cultural meanings are formed. This study used a tried and tested approach to narrative analysis to analyse the transcribed narrative of one man, Gary, who was experiencing mental health problems. The study explores Gary's process of meaning making as it appears in his narrative; the frameworks and metaphors that he uses to help him make sense of his experiences. The tensions between Gary's internal voices and beliefs and the external voices of surrounding culture and psychiatry are highlighted. Emphasis is placed on the importance of attending and responding to personal meanings embedded in narratives as a means of developing sensitive nursing care and enriching nursing research.
The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.
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