Self-Management Education for Bipolar Disorders: A Hermeneutic-Phenomenological Study on the Tacit Knowledge of Mental Health Nurses.

Background: Self-management of bipolar disorder (BD) education is a complex nursing intervention in which patients and informal caregivers are taught to be actively involved in self-monitoring and self-regulating activities. Some studies question if nurses are sufficiently equipped to deliver these educational tasks. Other studies suggest that nurses have gathered their knowledge implicitly by experience, but to date, this tacit knowledge is not described from the experiences of mental health nurses (MHNs) in ambulant BD care. Objective: To detect the tacit knowledge used by MHNs by interpreting their experiences in delivering self-management education to people with BD and their informal caregivers. Methods: A phenomenological-hermeneutical study amongst MHNs (N = 9) from three ambulant BD care clinics in the Netherlands. Face-to-face, open, in-depth interviews guided by a topic list, were conducted and transcribed verbatim prior to the hermeneutical analysis. Findings: We found five categories resembling the complex character of self-management interventions provided by MHNs: Building a trustful collaboration, Starting a dialogue about needs and responsibilities, Explaining BD, Utilizing mood monitoring instruments, and Conceptualizing self-management of BD. Conclusion: Eventually MHNs use tacit knowledge to cope with situations that demand an outside-the-box approach. Self-management education is partially trained and partially mastered through experience. Practice implications: In order to facilitate long-term self-management of BD, the collaboration of a supporting network is essential.

Show yourself, a short film to show professionals at an admission ward your 'euthymic being' during an admission for mania.

BACKGROUND: The progress and recovery of a patient with mania during hospitalization is differently seen by professionals working at an admission ward and by relatives of the patient. Professionals often indicate that the situation of the patient is improving while relatives estimate the improvement to be minimal in relation to the recovery of the patient. OBJECTIVE(S): To develop an intervention to give professionals at an admission ward an impression of the patient in a euthymic mood state to provide professionals with information to plan and conduct individualized patient centred care. METHODS: Professionals, patients, and relatives were individually interviewed about the preferable content and use of a film in which patients' shows their 'euthymic being'. Content analysis was performed. RESULTS: An outline for the content and use of the film was developed. CONCLUSIONS: The intervention holds promise for clinical practice, but further development and testing is necessary.

Caregivers experiences of nursing care for relatives hospitalized during manic episode: A phenomenological study.

PURPOSE: To describe the experiences of informal caregivers with the nursing care received by relatives hospitalized for mania. DESIGN AND METHODS: Multicenter phenomenological study using open interviews. Data were analyzed using the Stevick-Colaizzi-Keen method. FINDINGS: The essence of the experiences was the importance of communication, about being informed and involved in treatment during hospitalization of their relative. The experiences depended on the nature of the relation between participant and relative. PRACTICE IMPLICATIONS: Nurses should listen to caregivers' experiences, inquire about the expectations of caregivers regarding nursing care, and advise informal caregivers on how to take care of their relatives.

Identifying and describing patients' learning experiences towards self-management of bipolar disorders: a phenomenological study.

ACCESSIBLE SUMMARY: Existing evidence suggest that patient education in promoting self-management strategies of bipolar disorder (BD) is effective. However, results across the full range of service users with BD vary. Learning experiences of service users look to be a crucial factor to take into account when designing, delivering, and evaluating effective interventions that promote self-management in chronic illness. What learning activities service users actually undertake themselves when self-managing BD that might explain varying success rates, and guide future self-management educational programmes has not been examined. Unlike previous studies that suggest that outcomes in self-management depend on individual learning activities, the current study found that learning to self-manage BD takes place in a social network that functions as a learning environment in which it is saved for service users to make mistakes and to learn from these mistakes. Especially, coping with the dormant fear of a recurrent episode and acknowledging the limitations of an individual approach are important factors that facilitate this learning process. Practitioners who provide patient education in order to promote self-management of BD should tailor future interventions that facilitate learning by reflecting on the own experiences of service users. Community psychiatric nurses should keep an open discussion with service users and caregivers, facilitate the use of a network, and re-label problems into learning situations where both play an active role in building mutual trust, thereby enhancing self-management of BD. ABSTRACT: Existing evidence suggest that self-management education of bipolar disorder (BD) is effective. However, why outcomes differ across the full range of service users has not been examined. This study describes learning experiences of service users in self-managing BD that provide a possible explanation for this varying effectiveness. We have conducted a phenomenological study via face-to-face, in-depth interviews, guided by a topic list, along service users with BD I or II (n = 16) in three specialised community care clinics across the Netherlands. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7. Unlike existing studies, which suggest that individual abilities of service users determine outcomes in self-management of BD, the current study found that self-management of BD is a learning process that takes place in a collaborative network. We identified five categories: acknowledgment of having BD, processing the information load, illness management, reflecting on living with BD, and self-management of BD. The success of self-management depends on the acknowledgment of individual limitations in learning to cope with BD and willingness to use a social network as a back-up instead. Especially, the dormant fear of a recurrent episode is a hampering factor in this learning process.

Recognising prodromes of manic or depressive recurrence in outpatients with bipolar disorder: a cross-sectional study.

BACKGROUND: There is some evidence that teaching patients to recognise prodromes of manic and depressive episodes improved time to recurrence and hospitalization, social function, and performance in employment. Little information is available about which prodromal symptom patients with bipolar disorder recognise as being the very first symptom of recurrence. OBJECTIVES: The aims of this study were to describe the very first symptoms in manic or depressive recurrence reported by patients with bipolar disorder and to explore associations between the ability to recognise these prodromal symptoms and the clinical characteristics of these patients. DESIGN: A cross-sectional, descriptive design. SETTINGS: Five psychiatric outpatient clinics in the Netherlands. PARTICIPANTS: 111 outpatients diagnosed with bipolar disorder, currently not in an episode. METHODS: Data were obtained through a face-to-face interview with open ended questions and a questionnaire for demographic and clinical characteristics. Reported prodromes were categorised in an instrument inductively constructed and based on literature review and expert opinion. Associations were calculated with chi squares. RESULTS: The first recognised symptom of recurrence in mania was change in energy level (21%), sleep (17%), and social functioning (16%). In depression it was change in thought (15%), mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%). Twenty-eight percent of the patients were not able to recognise prodromes of recurrence in mania. Also 28% was not able to recognise prodromes of depression, and 12% was not able to recognise either of them. A significant association (p=0.033) was found between the ability to recognise prodromes of depression and the lifetime number of depressive episodes. CONCLUSIONS: The majority of euthymic patients with bipolar disorder are able to recognise prodromes of recurrence. These warning signs often emerge early in the process of recurrence. Our results suggest that patients learn to recognise prodromes of recurrence rather by experience than from therapeutic interventions. Talking to patients and their relatives closely after recovered from an episode to construct the early phase of recurrence can be important to improve recognition and prevent future episodes of mania or depression.

Family caregiving in bipolar disorder: caregiver consequences, caregiver coping styles, and caregiver distress.

AIMS: This study investigated the consequences caregivers of outpatients with bipolar disorder are confronted with, the distress they experience and their coping styles. METHODS: Caregivers (n = 115) were asked to complete the Involvement Evaluation Questionnaire (IEQ) to measure caregivers' consequences, the Utrecht Coping List (UCL) to measure caregivers' coping styles, and the 12-item General Health Questionnaire (GHQ-12) to measure caregiver distress. Scale (sub)scores were calculated and relationships between the results were explored. RESULTS: Caregiver consequences were found to be limited, although approximately 30% reported distress. Male caregivers used a more avoiding coping style and undertook activities to provide diversion. Female caregivers used a less active approach and sought less social support. Correlations were found between the IEQ overall score and its subscales 'tension' and 'worrying' and the UCL subscales 'palliative reaction pattern' and 'passive reaction pattern'. Distress appears to occur more often in caregivers who report more consequences, tend to use a more avoiding coping style, and have a more passive reaction pattern. CONCLUSIONS: Clinicians should assess symptoms of caregiver distress. When caregiver distress is noticed, efforts should be undertaken to support the caregiver and teach them skills to cope effectively with the consequences they experience in order to stay well.

Patient aggression in clinical psychiatry: perceptions of mental health nurses.

Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and addition care, has initiated a project to decrease the number of seclusions in clinical psychiatry. A first step in this project is to gain insight into the current situation: the perceived prevalence of patient aggression, the attitudes of mental health nurses towards patient aggression and those socio-demographic and psychosocial factors that contribute to the use of coercive interventions. A survey was undertaken among 113 nurses from six closed and semi-closed wards. In this survey, two questionnaires were used: (1) the Attitude Toward Aggression Scale; and (2) the Perceptions of the Prevalence of Aggression Scale. Variables derived from the Theory of Planned Behaviour were also measured. Nurses reported being regularly confronted with aggression in general and mostly with non-threatening verbal aggression. They perceived patient aggression as being destructive or offensive and not serving a protective or communicative function. The nurses generally perceived themselves as having control over patient behaviour (i.e. considerable self-efficacy) and reported considerable social support from colleagues. Although the nurses in this study were frequently confronted with aggression, they did not experience the aggression as a major problem.

Burden, coping and needs for support of caregivers for patients with a bipolar disorder: a systematic review.

This study was aimed to highlight the factors which influence experienced burden, coping and needs for support of caregivers for patients with a bipolar disorder. Research articles meeting content and methodological quality criteria from January 1995 through October 2005 were reviewed. High objective and subjective burden is experienced by these caregivers. Subjective burden is extremely influenced by illness beliefs. High burden is associated more with severity of symptoms (than diagnosis), difficulties in the relationship with patient, lack of support and stigma. Coping is influenced by appraisal and burden. Different phases in the process of caregiving require different coping mechanisms. Little research is available on effectiveness of coping mechanisms and needs for support. Suggestions are nevertheless found in the literature for professional support. Caregivers of patients with a bipolar disorder experience high burden and try to cope in different ways. Little research is available on coping styles and needs for support. However, recommendations can be made to increase support for these caregivers.

Self-reported care needs of outpatients with a bipolar disorder in the Netherlands.

The care needs of patients with a bipolar disorder have not been studied to date. In the present research, the care needs, care received and unmet care needs for a population of outpatients with a bipolar disorder in the Netherlands are described. The participants (n = 157) completed the Need for Care Questionnaire and a questionnaire addressing various demographic and clinical characteristics. The results show the care needs to mainly involve the domains of psychological help, psychiatric help and social functioning. Unmet needs are frequently reported for all domains and found to be particularly frequent for needs on social functioning. Some significant associations between source of income, number of hospitalizations and involvement of community psychiatric nurses, on the one hand, and reported care needs, on the other hand, are identified and discussed. Incorporation of needs assessment into the treatment process is recommended in the form of structured questionnaires which can also then be used to guide and evaluate the treatment process. Future research should focus on the identification of the specific risk factors for particular care needs and thereby work to minimize the occurrence of such risk factors and promote early intervention efforts to reduce the burden on patients and their relatives.