An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Lunacy revisited. The influence of the moon on mental health and quality of life

The idea that the stars and planets may influence human health and behavior can be traced to at least Roman times, and research suggests a high proportion of health professionals continue to hold this belief. Nevertheless, evidence for the supposed influence of the moon on human behavior has proved particularly elusive, and research has tended to suffer from weaknesses in methodology and data analysis. This article reports findings drawn from a re-analysis of data from a research study into the functioning of a sample of mentally ill people living in the community. The mental health and quality of life of a sample of 100 people were assessed on four occasions during a 30-month period. Data were aggregated to represent the span of one lunar month, with scores being allocated to the relevant week of the lunar cycle during which each assessment was made. Comparison of mean values across the weeks of the lunar cycle was preformed using the ANOVA, Results showed significant change at the time of the full moon only in subjects with a diagnosis of schizophrenia (n = 56), where deterioration was observed in three areas of psychopathology and one area of quality of life. Some implications for nursing practice are discussed, and it is suggested that future research into the possibility of a lunar effect on human life should focus on the direct measurement of functioning in people with schizophrenia.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range?=?70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Decreased psychopathology & family burden. Associated with clozapine treatment of patients with refractory schizophrenia

1. Intensive multimodal treatment produces measurable gains in community functioning of people with schizophrenia and reduces family burden. 2. Families that were more involved with patients were more satisfied. 3. Money directed at intensive management and rehabilitation decreases hospitalization and increases community functioning of people with schizophrenia.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

Influencing alcohol control policies and practices at community festivals

The goal of this study was to assess the feasibility and effectiveness of two interventions aimed at reducing alcohol-related risks at community festivals--a training program for festival planners and a community organizing campaign. We randomly selected four festivals for each intervention and had 24 comparison festivals. Our assessment included process evaluation to track and evaluate types of alcohol policies resulting from each of the interventions, pre and post telephone surveys of key festival planners and law enforcement agencies, and pre and post pseudo-underage and pseudo-intoxicated purchase attempts. Analyses showed that both interventions were feasible and were successful in influencing adoption of written policies and improving alcohol-related practices. However, neither intervention appeared to decrease propensity for illegal alcohol sales at these events, likely due, in part, to the short time frame of the interventions. Future research should assess effects of the interventions on alcohol-related problems and effects of enforcement interventions.     

Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses

Falls are a daily occurrence in nursing homes and few interventions for reducing fall-related injuries have proven to be effective. Impact absorbing flooring (IAF) in residential care has shown promising results in reducing fall-injuries and in the process of developing and implementing IAF all aspects are valuable to explore. Therefore, the aim of this qualitative study is to describe the enrolled nurses (ENs) experiences of IAF. We carried out focus group interviews with ENs and used content analysis to process the data. The ENs experienced both negative and positive aspects with the IAF. Importantly, the ENs perceived the IAF as effective in preventing fall-injuries. They also appreciated the improvements in acoustics. Negative aspects were that the flooring initially was challenging to walk on and that it made it harder to maneuver heavy equipment. A significant and transferable finding in this study was the importance of the ENs' perceived difficulty in preventing fall-injuries amongst elderly people living in nursing homes. This seemed to be a driving force to accept the intervention. Although IAF affects the working conditions in a nursing home, ENs are willing to accept these issues given the perceived effectiveness of the intervention.     

Telephone therapy: call for help.

1. Many disabled people are unable to take advantage of community resources because they cannot leave their homes, but the telephone can provide a link to psychotherapeutic services. 2. In both telephone and office therapy, the therapist orients members to the group, suggests an arena in which goals might be established, encourages verbalizations, sharing of concerns, strategies for solving problems, and assesses the psychodynamics of the therapeutic situation. 3. Psychotherapy via telephone can provide significant benefits to people who formerly were barred from services. Telephone therapy requires the therapist's commitment to the challenge of mastering a new technique and to altering fee structures to allow those on fixed incomes to be served.     

Factors That Explain Marital Happiness When a Spouse Lives in a Nursing Home: Married but Living Apart

ABSTRACT

Little attention has been given to factors that affect the marital happiness of well spouses when their partners reside in nursing homes. Using two established scales, a telephone survey of 60 community dwelling individuals whose spouses were being cared for in nursing homes across Ohio was conducted. Multiple regression analysis indicated factors that contributed to the degree of happiness in the marital relationship were the amount of time married and coping techniques associated with mobilizing resources, social support, and spiritual support. These variables accounted for 35% of the variance in participants' stated degree of happiness with their marital relationship.     

Schizophrenia Fellowship of Australia,Inc.

One of the most stigmatized health areas is mental health, so the feasibility of a self-help organization to assist those with the common mental illness, schizophrenia, was contemplated with some misgivings by the Victorian Mental Health Authority in 1977. However, as it was departmental policy to encourage community involvement in alleviating mental illness and its associated problems, a number of relatives of people with schizophrenia were contacted to assess their reaction to the proposition. The response was positive and eight relatives agreed to become a steering committee to organize a public meeting to put forward the idea of forming a self-help organization centred on schizophrenia.     

Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Older people's experiences of community life: patterns of neighbouring in three urban areas

This paper examines changes to the community life of older people living in three urban areas of England: Bethnal Green, Wolverhampton and Woodford. All three were the subject of classic community studies in the 1940s and 1950s, these providing rich material about the lives of groups such as elderly people. Using this earlier research as a baseline, the paper presents data on how the experience of living in urban neighbourhoods has changed for older people in the intervening years. The article reviews the relationship between elderly people and their neighbours, drawing on quantitative as well as qualitative data. In conclusion, the paper identifies a number of general arguments pointing to the value of a community and locality perspective for understanding the impact of social changes on later life.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

The history, economics, and financing of mental health care. Part 2: The 20th century

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.     

Determinants of Irish emigration: a note

Factors affecting migration in Ireland are analyzed using data from 271 young people living in a rural community in County Cavan. The data were collected in a 1965 survey and followed-up in 1968. The author applies logit analysis to identify the factors that most influenced people to leave such a community.