Les unités de soins intensifs psychiatriques (USIP) : expériences françaises et internationales

Psychiatric Intensive Care Units (PICU) propose a secure setting for patients with acute behavior disturbances who can not be managed in psychiatric general wards. Physical violence acts against patients or hospital staff, substance abuse, non-compliance for care and treatment, intensity of symptoms or absconding are frequent motives for admission. Patients are compulsorily detained in secure conditions. They are admitted from psychiatric facilities of a health area or by agreement between hospitals. Multidisciplinary working in psychiatric intensive care is essential, delivered by qualified staff. Care and treatment must be centered on the patient, multidisciplinary, intensive, comprehensive with an immediacy of response to critical situations. As length of stay should not exceed 2 months in duration, interface and liaison with original services of patients are important issues. In France, PICU exist notably at Cadillac, Lyon, Paris, Nice, Eygurande, Montpellier, Pau and Prémontré. These facilities appear as a missing level, an interesting alternative in mental health care system, between psychiatric general wards and maximum security hospitals. This paper reports the creation of a National Association of PICU in France, the existence of national minimum standards and international experiences.     

Web-based remote psychological intervention improves cancer treatment

Web-based-remote (WBR) intervention is a new approach that incorporates smart control technology and modern medicine to monitor patient compliance. It is based on computer control and communication technology. This study is to explore the benefits of WBR psychological intervention for cancer treatment. 128 patients diagnosed with cancer by Pathology Department of our hospital between 1 February 2013 and 1 August 2013 were included. Patients were randomly assigned to intervention and control group (n = 64). The Questionnaire-Core 30 (QLQ-C30) was used for the survey. Intervention group received WBR psychological intervention in addition to regular clinical follow-up care. Control group only received regular clinical follow-up care. The QLQ-C30 score was significantly better in the intervention group than the control group when the intervention and control groups were followed for three months. In conclusion, WBR psychological intervention substantially improves the quality of life in patients during cancer treatment.     

Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing

A considerable body of research has accumulated regarding aggression toward health care staff, yet little is known about the contextual factors involved. The present study examined the context within which aggressive incidents occurred and the dynamics of the interaction between staff and patients. Two aspects in particular were investigated; firstly, whether incidents were preceded by some anxiety provoking stimulus and secondly, the assailants' levels of cognitive processing apparent at the time of the incident. A prospective study collected data concerning incidents of physical assault and threatening behaviour in a general hospital. Staff were interviewed soon after the incident occurred. A content analysis determined that 82.8% of incidents involved experiences delivered by the staff victims likely to have provoked anxiety in the assailant. Most commonly, incidents involved staff intervening in the patient's intended behaviour. In addition, in 64% of cases, assailants were actually displaying some impairment in cognitive processing at the time of the incident Data suggest that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member's actions. Patients who do not appear to understand what is happening may require additional time and effort to ensure they comprehend fully and accept what the staff member is intending to do, particularly if patients are experiencing an event likely to increase anxiety levels. Aggr. Behav. 30:534–543, 2004. © 2004 Wiley‐Liss, Inc.     

People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis

This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients’ access to proactive care.

     

A model for outpatient care

Chaplains have seriously discussed outpatient care for a number of years. This article describes a model of thorough and intentional outpatient care that is practiced in conjunction with an inpatient care to cancer populations. Rationales, values, institutional dynamics, and clinical care are discussed. Although the focus is on outpatient care where slightly more than 50% of personnel resources are invested, the care also occurs in the context of both inpatient care and follow-up care after discharge to home. A general model of spiritual and religious care and more specific models pertinent to hematopoietic stem cell transplant populations and general oncology populations are described. The models attend times of distress and times of "ordinary" and celebratory experiences, attend care of patient, caregiver, and staff.     

Reducing obstacles to the provision of quality diabetic care

Abstract

High quality diabetic care is seen as influenced by the organisation of care, health care workers' involvement in diabetes-specific areas, co-operation among staff members, the availability of resources, and the competence of medical staff (including both physicians and nurses). In a prospective study we have tested a programme for improvements of the quality of diabetes services which combined organisational development and continuing medical education (CME) measures. The study involved 34 primary health care centres over an 18 month period and was based on the responses to questionnaires answered by 123 general practitioners and 247 registered nurses at the 34 PHCCs.

The combined programme had a considerable influence on inter-group co-operation, staff members' perceptions of resources available, and nurses' involvement in diabetic care (54 versus 30% seeing diabetic patients for regular check-ups).

The results show that, in order to diminish obstacles to high quality care, organisation of care as well as care workers' theoretical knowledge has to be focused.     

Exploring the lived experiences of infertility treatment and care by involuntarily childless women

This study explored the lived experiences of fertility treatment and care by South African women with infertility. A total of 21 women from different age and ethnic groups (age range = 26 to 41; whites = 53%, coloured = 47%) were interviewed for the study. The women responded to semi-structured interviews on their lived experiences of fertility treatment and care whilst undergoing treatment. The data were analysed using thematic analysis. Four main themes were identified in the study; including: lack of compassionate care from treatment care providers, the need for infertility clinics to integrate psychosocial support care, a need for continuing education for fertility staff, as well as financial support resourcing. Participants expressed a need for health care staff at fertility clinics to be more attentive to their emotional and psychological needs. In addition, participants perceived a need for psychosocial care as a result of the distressing nature of the treatment process. The women also felt that some health care staff lacked technical knowledge about the fertility treatments and this left them deprived of crucial information. The costly nature of fertility treatment presented as an added burden for participants. Overall, participants seemed to require a more individualised and patient centred form of fertility care.     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

The framework of psychoanalytically oriented psychotherapy with traumatised patients and the institution

Abstract

Lindbom-Jakobson M, Lindgren L. The Framework of Psychoanalytically Oriented Psychotherapy with Traumatised Patients and the Institution. Int Forum Psychoanal 1997;6:217-224. ISSN 0803-706X.

Psychotherapies performed at multidisciplinary institutions will be influenced by the ongoing dynamics and inevitable group processes of the institution. The difficulties of these processes become extremely hard to handle when the patient category is a severely traumatised one. The prerequisite of psychoanalytically oriented psychotherapy, the illusion of the sealed room and fixed framework, gets disturbed by the information flow in an institution. The institutions for these patients tend to become stages on which the patients as well as staff can perform and repeat their intrapsychic and interpersonal conflicts, non-adaptive defences and disturbed object relations. The predominant dynamic that arises around tortured refugees as a patient category is sado-masochistic relating.     

The relative importance of patients’ decisional control preferences and experiences

Objective: Patients’ role in treatment decision-making can influence psychosocial and health-related outcomes (i.e. satisfaction, felt respect, adherence). We examined decisional control in a surgical context, identifying correlates of patients’ preferences and experiences.

Design: 380 patients and 7 surgeons were surveyed during initial surgical consultation visits in a low-income outpatient clinic.

Measures: Patients reported preferences for (pre-consultation) and experiences of (post-consultation) decisional control, demographics, satisfaction with care, and adherence to treatment recommendations. Surgeons rated patients’ health status.

Results: Preferences for and experiences of decisional control were unrelated, suggesting significant preference–experience misalignment. However, this misalignment did not appear to be consequential for patient outcomes. Rather, more decisional control, regardless of patients’ preferences, predicted greater satisfaction with care and greater self-reported adherence as assessed at a post-surgical appointment.

Conclusions: Decisional control predicts better outcomes for patients, regardless of their preferences for control over treatment decisions. These findings suggest that interventions should aim to increase patients’ degree of decisional control when feasible and appropriate.     

People with intellectual disability as neighbours: Towards understanding the mundane aspects of social integration

Although people with intellectual disabilities (ID) are increasingly expected to relocate from traditional institutional care to ‘regular’ neighbourhood housing facilities and socially integrate in these neighbourhoods, little is known about how they are perceived and appreciated as neighbours. This paper reports on interviews carried out with 30 neighbours without ID who were neighbours of small‐scale care facilities for people with ID. Interviews addressed the neighbours' everyday experiences of neighbouring in general, and neighbouring people with ID in particular. Neighbouring, for these informants, called for a fine balance between friendliness without over‐involvement. While they were generally positive about their interactions with their neighbours with ID, it emerged that the formal nature of the care facility and the interaction style of some of the neighbours with ID often contravened informants' assumptions about neighbouring. Informants expressed concern about a possible lack of appropriate distance, reciprocity and accountability among their neighbours with ID. The nature of the care facility, with paid staff, often group activities, formal means of achieving the everyday small tasks which neighbours sometimes do for each other, and a high turnover of residents, all undermined the possibility of a typical neighbourly relationship. In conclusion, we suggest that integration of people with ID into everyday neighbouring relationships raises complex challenges for care organizations that need to find a balance between supporting the needs of people with ID they care for, adequate support and mediation for other neighbours when necessary, and all the while avoid becoming overly involved in neighbouring as a formal partner. Copyright © 2010 John Wiley & Sons, Ltd.     

The effects of an improved residential nursery on the development of young Japanese children

The author, acting both as a researcher and a staff member, intervened at the residential nursery to facilitate the development of the children. The main goal of the intervention was to establish attachment relations between infants and their caretakers. The living environment of the institution simultaneously improved with the home-like atmosphere of small group care. Children's developmental status was examined before and after the intervention. The improved organization of the nursery was significantly correlated with the social (fear of stranger) and verbal (single word; first sentence) development of infants. This study showed how to facilitate normal development in children by improving residential nursery life. The results of two follow-up surveys in family-like residential nurseries, conducted independently in Germany and Japan, showed that early negative family experiences may be offset by favorable influences later in life, even at institutions. These findings suggests that quality of substitute care and family-like conditions, rather than residential care itself, may be the more important influences on children.     

Preventive work in a toddler group and nursery

This paper is about the sort of preventive work which can be carried out in early child care settings where incipient disturbance can be picked up and worked with promptly and effectively. It shows how toddler groups and nurseries can offer relationships and experiences which encourage mutuality and progressive development, while at the same time addressing difficulties before they have become fully internalized. It gives a detailed account of work with a single mother and her son who attended first a toddler group run by a child psychotherapist and her trainee assistant, and then a nursery where staff were in regular consultation with the child psychotherapist who also worked individually with the mother. It argues that the effectiveness of such early interventions can be conceptualized in terms of supplying maternal and paternal functioning at a time when children and parents alike are particularly needful of and responsive to this sort of help.     

Treatment for Youth in Short-Term Care Facilities: The Impact of a Comprehensive Behavior Management Intervention

We describe a comprehensive program to train emergency shelter staff in effective methods for dealing with youth who have behavioral and emotional problems; assess the degree to which staff implemented the treatment approach; measure the impact of the intervention on shelter-wide incidents such as out-of-control behavior, runaways, and violence against other youth; and examine pre-post changes in staff experiences at the shelter via anonymous surveys. Overall, the short-term shelter staff indicated adequate implementation of the intervention. The rate of youth incidents at the shelter significantly declined from pre to post assessment. Direct-care staff ratings of their satisfaction with their proficiency in behavior management and teaching youth skills increased significantly from pre to post implementation. These findings suggest that it is feasible to deliver an effective staff-training program to improve the behavior management and social skills of youth residing in short-term care facilities within the child welfare system.     

Are immigrants in the nursing industry at increased risk of bullying at work? A one‐year follow‐up study

The purpose of this study was to explore whether (a) immigrant health care workers (HCW) are more at risk of bullying at work than Danish staff members, (b) this association is increased by previous exposure to bullying and (c) immigrants experience more bullying from supervisors, colleagues and clients/residents. We analyzed cross-sectional baseline data from 5,635 health care students of whom 10.4% were immigrants, and conducted a prospective analysis by following 3,109 of these respondents during their first year of employment. More than a third of the respondents had previous experiences with bullying. The baseline analyses showed that immigrants are more at risk of being bullied during both their theoretical education and trainee periods than their Danish co-students. At follow-up we found that 9.1% of the total cohort had been exposed to bullying at work during their first year of employment, hereof 1.8% frequently. "Non-Western" immigrants had a significantly higher risk of exposure to bullying at work during follow-up than the Danish respondents independent of previous experience with bullying. Danish and immigrant health care workers were more exposed to bullying from co-workers than from supervisors with no statistically significant difference between the Danes and the immigrant groups. Both "Western" and "non-Western" respondents were more at risk of bullying from clients/residents than the Danish respondents.     

Integrating the ivory tower and the treatment institution

Although the application of psychoanalysis to the clinical understanding of, and work with, psychotic and personality disordered patients has developed significantly over many years now, the presence of such an approach alongside other treatment modalities in many treatment settings can often be poor and sometimes absent. This in part reflects the complexity of developing both theoretical understanding and clinical technique in relation to these patients and in many settings a combination of interventions might well be the treatment programme of choice. In this paper, the author puts forward a view that in relation to recent developments in contemporary mental health services, specifically in the provision of care and treatment for forensic and anti-social personality disordered patients and offenders, the application of psychoanalysis might have a particularly important role to play. The experiences of staff working with patients and offenders who project their unprocessed internal anxieties and conflicts into the external environment can often be difficult and disturbing. The author argues that this dynamic needs to be understood as a representation of the patient's unmanageable internal world and, as such, careful attention has to be paid to this sometimes toxic impact on staff groups and care institutions. He argues that an application of psychoanalytic principles has a unique role in this reflective task which should be seen as a necessary and crucial part of the treatment process.     

Practice of Nursing Care Provided to Clients from Muslim Countries in the Czech Republic

Authors deal with practice of nursing care provided to Muslim clients in the Czech Republic. They use the explorative research design. By means of analyses of 21 semi-structured interviews with important social actors in the area of health care (spa resorts and hospitals). The study shows that Muslims are not homogeneous in their behaviour in the field of health care. In the spa environment, three interpretation perspectives can be found: the economic interpretation of a Muslim as the source of income of the Czech spa industry, which faces economic problems, the cultural interpretation developed within the spas (the experience capital of the staff and other clients), and the (a) cultural interpretation of Muslims and Islam brought to spas from the outside (the public opinion). However, in the area of hospitals, Muslims are not separated from the remaining categories of students; Muslim patients represent a small group of persons, and their treatment being conditioned by the distance or closeness of cultures, language skills, adaptation, and experiences with treatment in the Czech environment as perceived by the staff.     

Politics and emotion: Working with disadvantaged children in South Africa

This paper discusses the experience of consulting to organizations involved in the provision of care to disadvantaged groups of children in South Africa. It draws particular attention to the impact of South Africa's painful political history on the emotional life of these organizations. This has created an additional burden for organizational staff who often work under difficult conditions with very troubled groups of children. The paper highlights the common experiences of deprivation and loss, fears around the abuse of power and problems with acknowledging differences between people, which are a part of South Africa's political legacy. These kinds of issues were found to have a powerful impact on the functioning of organizations and also on the quality of the consultancy relationship itself. We argue that it is important to recognize the emotional demands of child-care work generally, but also that it is equally necessary work, through our political experiences, to achieve some kind of understanding of these. Lack of containment for these experiences will impact on the quality of care organizations are able to offer to children in our context.     

Patient experiences with treatment in private practice compared with public mental health services

The study compared patient experiences with psychiatric treatment provided by private practitioners and public outpatient clinics. Questionnaires were completed by 642 outpatients in private practice and 6,677 outpatients in public clinics. The questionnaire included a measure of patient experiences comprising six items: treatment outcome, enough time for contact and dialogue with clinician, clinicians' understanding of patient's situation, suitability of therapy and treatment, clinician follow-up of planned actions, and influence on treatment. Patients in private practice had generally better experiences than patients in public outpatient treatment. The difference between private and public patients was largest for patients with poor self-evaluated mental health or those who had just one consultation in the previous three months. Private practitioners appear to have an important role in mental health services delivery, and patients have relatively good experiences with services. Further studies that assess the patient - clinician interaction in different mental health services may give further insights into potential service improvements.