Boarding versus day-students: A mixed-methods analysis of sleep and its relationship with psychological distress.

BACKGROUND: Boarding students face unique challenges when entering school, including: adapting to a novel environment, where they are separated from family, friends and culture, for up to 40 weeks per year. A particular challenge is sleep. A further challenge is coping with the demands of boarding with its potential impact on psychological well-being. AIMS: To explore how boarders' sleep differs from that of their day-student peers, and how this relates to psychological well-being. SAMPLE AND METHODS: 309 students (59 boarding students and 250 day-students, at one Adelaide school) completed the School Sleep Habits Survey, Depression-Anxiety-Stress-Scale-21 (DASS-21), and Flourishing Scale. Boarding students additionally completed the Utrecht Homesickness Scale. Thirteen boarding students described experiences of sleeping in boarding through focus groups. RESULTS: Boarding students, compared to day-students reported 40 minutes more sleep per weeknight (p < .001), with earlier sleep onset (p = .026), and later wake-up (p = .008) times. No significant differences were observed between boarding' and day-students' DASS-21 scores. Hierarchical regression revealed longer total weekday sleep time predicted higher psychological well-being in both boarding and day-students. Additionally, in boarding students, low homesickness-loneliness and homesickness-ruminations further predicted psychological well-being. Thematic analysis of boarding students' focus group responses revealed that night-time routine, and restricting technology use at night facilitated sleep. CONCLUSIONS: This study supports - in both boarding and day-students - the importance of sleep for adolescent well-being. Sleep hygiene can play an important role in boarding student sleep, especially: regular night-time routine and restricting technology use at night. Finally, these findings suggest that poor sleep and homesickness have an adverse effect on boarding student psychological well-being. This study highlights the importance of strategies which promote sleep hygiene and minimize homesickness, in boarding school students.

Identifying and exploring linguistic expertise of psychiatrists in interviews with patients with thought disorder.

OBJECTIVE: To identify and understand the linguistic expertise of psychiatrists in clinical interviews with patients experiencing thought disorder (TD). METHOD: Qualitative analysis of 24 routine clinical interviews between psychiatrists and inpatients with TD. RESULTS: Psychiatrists demonstrated the expertise with which they navigated clinical interviews and accomplished shared goals with patients experiencing TD. These findings highlight the need to rethink the notion that such patients are incapable of productive communication. Capturing and describing psychiatrists' tacit expertise provides a foundation for documenting an under-recognised skill set. CONCLUSIONS: Understanding such expertise could enhance the care of patients with TD, repositioning them as active participants in the accomplishment of shared therapeutic goals. Teaching these skills to mental health clinicians during their training would improve their ability to establish effective therapeutic relationships with these patients.

Older people with dysphagia: transitioning to texture-modified food.

Older people with dysphagia are at high risk of malnutrition. To maintain safe oral and nutritional intake, solid food may be texture-modified. Little is known about the transition experiences of older people who move from normal to texture-modified foods. The aim of this study was to describe residents' experiences as they transitioned from normal food to texture-modified food. The study used a qualitative descriptive design and individual interviews were conducted with a study group of 28 participants (residents, family members, nursing and care staff, and speech and language therapists). The interviews were thematically analysed. The findings suggest that transition creates the risk of distress, reducing eating to a matter of necessity and hunger, and that the process is perceived as abrupt, and characterised by lack of communication and awareness of the need for change. A key finding is that the language used during transition can be adversely affected by the management of risk. This language promotes a culture of care that emphasises the limitations of residents, reduces their motivation to eat and hinders the delivery of person-centred care. The findings suggest that care facilities for older people need to revisit their dysphagia management protocols to ensure that they support a person-centred approach for recipients of texture-modified food.

Homework setting in cognitive behavioral therapy: A study of discursive strategies.

In recent years cognitive behavioral therapy (CBT), a form ofpsychotherapy, has risen to prominence due to a large number of studies attesting to its efficacy. A crucial part of the model of CBT is the use of the therapeutic strategy, homework, in which the client undertakes therapeutic tasks between sessions. The focus of this study is on how homework is implemented in sessions of CBT. This is undertaken through an analysis utilizing theme-orientated discourse analysis of video recorded sessions of CBT of one therapist and a client. Through tracking the focal theme of homework, the analysis focuses on homework as a face-threatening act (Brown and Levinson 1987) and how discursive strategies are employed to manage this issue. Other analytic themes include the use of frames (Goffman 1974) and constructed dialogue (Tannen 2007). It is the expertise of the therapist in putting into practice the therapeutic task of homework that is the subject of this study.

'I understand all the major things': how older people with limited English proficiency decide their need for a professional interpreter during health care after stroke.

OBJECTIVE: To explore the process of decision-making of older people with limited English proficiency (LEP) about using a professional interpreter during their health care after stroke. DESIGN: A constructivist grounded theory approach was used. Up to two in-depth interviews were conducted with 13 older people with LEP from seven different language groups, and one older person who preferred to speak English, who had recently received health care after an acute stroke. Professional interpreters assisted with 19 of the 24 study interviews. Data were analysed and theoretical processes developed using a constant comparative method. RESULTS: Professional interpreters were not a strong presence in the health care experience after stroke for participants. The use of professional interpreters was a complex decision for participants, influenced by their perception of the language and health care expertise of themselves and others, their perceived position to make the decision and whom they trusted. Getting by in English allowed participants to follow rules-based talk of health professionals, but did not enable them to understand detailed information or explanation, or to engage in the management of their condition in a meaningful way. CONCLUSION: Health professionals have an opportunity and a mandate to demonstrate leadership in the interpreter decision by providing knowledge, opportunity and encouragement for people with LEP, to use an interpreter to engage in, and understand, their health care after stroke. Health professionals may need to advise when interpretation is needed for health care situations, when communication difficulties may not be anticipated by the person with LEP.

Qualitative studies using in-depth interviews with older people from multiple language groups: methodological systematic review.

AIM: This paper is a report of a methodological review of language appropriate practice in qualitative research, when language groups were not determined prior to participant recruitment. BACKGROUND: When older people from multiple language groups participate in research using in-depth interviews, additional challenges are posed for the trustworthiness of findings. This raises the question of how such challenges are addressed. DATA SOURCES: The Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Ageline, PsycINFO, Sociological abstracts, Google Scholar and Allied and Complementary Medicine databases were systematically searched for the period 1840 to September 2009. The combined search terms of 'ethnic', 'cultural', 'aged', 'health' and 'qualitative' were used. REVIEW METHODS: In this methodological review, studies were independently appraised by two authors using a quality appraisal tool developed for the review, based on a protocol from the McMaster University Occupational Therapy Evidence-Based Practice Research Group. RESULTS: Nine studies were included. Consideration of language diversity within research process was poor for all studies. The role of language assistants was largely absent from study methods. Only one study reported using participants' preferred languages for informed consent. CONCLUSION: More examples are needed of how to conduct rigorous in-depth interviews with older people from multiple language groups, when languages are not determined before recruitment. This will require both researchers and funding bodies to recognize the importance to contemporary healthcare of including linguistically diverse people in participant samples.

Accomplishments of the thought disordered person: a case study in psychiatrist-patient interaction.

BACKGROUND: The research and clinical literature portrays the thought disordered person as incapable of meaningful social interaction. This model views thought disorder exclusively as a brain dysfunction, evidenced by dysfunctions in speech. AIMS: The study seeks to address this deficit model by investigating the interactional accomplishments of thought disordered people in clinical interviews. METHOD: An analysis of clinical interview data. RESULTS: We investigate (1) what thought disordered people actually accomplish in interaction, and (2) how thought disordered people and their psychiatrists routinely communicate on matters consequential for treatment. CONCLUSIONS: This paper introduces a new perspective on the interactional achievements of people with thought disorder. The skills required by both parties during routine clinical interviews have not previously been recognised or described.

The negotiation of the problem statement in cognitive behavioural therapy.

Cognitive behavioural therapy (CBT) is a form of psychotherapy which is characterized by being highly structured, outcomes focused and time limited. The literature concerning CBT is extensive but it has primarily focused on the outcomes of therapy with limited qualitative studies investigating the process of CBT. In this present study we investigate how the CBT model is implemented in therapeutic interaction through a focus on the conversion of the client's problem into CBT terms and its ultimate articulation as the problem statement. The problem statement is an integral part of the form of CBT studied from which the subsequent therapy is derived. Drawing on theme-oriented discourse analysis we examine the first two sessions of the treatment of one client using a number of tools derived from discourse and conversation analysis. This case study was drawn from a larger corpus of the CBT treatment often clients. The expertise of the therapist in applying the generic CBT model of therapy to the client's particular problem is a focus of this study.