Improving Quality of Life for Patients with Serious Mental Illness - - PowerPoint PPT Presentation

Improving Quality of Life for Patients with Serious Mental Illness

Linda D. Gerson, PHD, RN, PMHCNS-BC Johns Hopkins University School of Nursing

Why this focus?

• US Surgeon General’s Report (1998)

– Impact of untreated mental illness

• IOM Report: Unequal Treatment (2002)

– Racial and ethnic disparities

• President’s New Freedom Commission

Report (2003)

– Problems in delivery of effective health care to mentally ill persons in US – Call to transform healthcare system to become more consumer and family-oriented

Prevalence of Serious Mental Illness Among US Adults

Data Courtesy of SAMHSA

Purpose of this pilot study

• Identify individual and family perceptions
• f their mental health care experience
• Target interventions that are responsive to

individual and family needs

Procedure

• Informed consent and contact information
• Home visits
• Patient and family interviews

Instruments

• Brief Psychiatric Rating Scale (Overall & Gorham, 1962
• Personal Resources Questionnaire (PRQ) Part II (Weinert,

1988)

• Ways of Coping Checklist (Folkman, Lazarus, Dunkel-

Schetter, DeLOngis, & Gruen, 1986)

• Camberwell Assessment of Need Short Appraisal

Schedule (MacPherson, Varah, Summerfield, Foy, & Slade, 1999)

• Client Satisfaction Questionnaire (CSQ) (Larsen, et al.

1979)

• Four open-ended interview questions

Data Analysis

• Descriptive statistics
• Measures of central tendency
• Manifest and latent content analysis

(Rose, 2012 developed codes)

Characteristics of study participants

• 10 participants
• Ages 23-81 years
• All were African American
• 6 men, 4 women
• Diagnosis of schizophrenia, major

depression, or bipolar disorder

Results

• BPRS—not enough difference in scores between

Time 1 and Time 2 to support improvement

• PRQ—increased social support immediately after

discharge, but less as time went on

• Ways of Coping—little change in coping over

time

• Camberwell—unchanged from Time 1 to Time 2.

Unmet needs:

• Daytime activity
• Intimate relationships
• Help with reading and writing

Interview Findings

• Concern about on-going symptoms and difficulty

managing them

• Adjustment to community impacted by:
• Follow up care
• Family support
• Patient perception of health status
• Family

– Resignation – Frustration – discouragement

Recommendations

• Provide support after hospital discharge for

both patients and their family members

• Add structure and activities to patient’s daily

routine

• Enhance community-based treatment

programs by focusing on communication of patient and family goals

• Create a strong therapeutic alliance with the

patient and their family

References

• Folkman, S., Lazarus, R., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. (1986).

Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 992-1003.

• Larsen, D., Attkisson, C., Hargreaves, W., & Nguyen, T. (1979). Assessment of

client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197-207

• MacPherson, R., Varah, M., Summerfeld, L., Foy C., & Slade, M. (2003). Staff and patient

assessments of need in an epidemiologically representative sample of patients with psychosis: Staff and patient assessment of need. Social Psychiatry & Psychiatric Epidemiology, 38, 662-667.

• Overall, J., & Gorham, D. (1962). The brief psychiatric rating scale. Psychological Reports,

10, 799-812.

• Weinert, C. (1988). Measuring social support: revision and further development of the

personal resource questionnaire. In C. Waltz & O. Strickland (Eds.), Measurement of Nursing Outcomes (pp. 309-327). New York: Springer.

QUESTIONS AND DISCUSSION

Contact Information

• Linda D. Gerson, PhD, RN, PMHCNS-BC
• Johns Hopkins University School of Nursing
• 525 N. Wolfe Street
• Room 416
• Baltimore, Maryland 21205 USA
• Telephone: 1-410-614-5747
• Email: lgerson1@jhu.edu