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Mental Health and Palliative Care: Exploring the Ideological Interface. International Journal of Psychosocial Rehabilitation.
This paper seeks to address this hiatus by presenting findings from a qualitative research project on end-of-life care for patients in a mental health institution called The Park, Centre for Mental Health, located in Brisbane, Queensland, Australia.
In particular, this discussion will focus on the findings from the project which highlight the similarity in philosophy between palliative care and mental health practice.
The similarity which includes a person centred practice, relationship- based connectedness, a belief in compassionate, holistic care, respect for autonomy and choice, quality of life issues, family as the unit of care and need for a democratic and multi- discipline work teamwill be described.
It will be argued that the common philosophical meeting ground is an excellent foundation for integrating palliative care, now recognised as best-practice end-of-life care, into mental health service delivery.
In short, the shared practice values and vision between these two disciplines provide an optimistic starting point from which to plan to address the lack of hospice and palliative care service delivery in mental health.
Introduction The mental health literature indicates that there are many factors that point to the need for serious consideration of end-of-life issues for psychiatric patients. Foremost of these concerns is the excess mortality and higher case fatality rate for patients within the mental health system with cancer.
Indeed, the evidence indicates that high rates of medical co- morbidity and premature death are now considered normative health outcomes for individuals with mental illness 2.
Mortality among psychiatric patients not only remains high, but there is evidence that it is increasing 3. The second concern is that mortality concerns in mental health are not just associated with traditional palliative care diagnostic categories, but extend to the equally serious incidence of death by suicide 4,5.
Studies of psychiatric patients indicate that the highest cause-specific mortality rate is for deaths due to suicide 3. Of considerable worry is the fact that excess mortality risk is concentrated in the first few years after first contact with mental health services 3.
In summary, then, statistical information demonstrates that people with a mental illness have an excess mortality, a reduced life expectancy and die from ten to fifteen years earlier than the general population 2,6,7,8.
The only work that exists is about liaison psychiatry working with patients with stress and depression in mainstream hospice services 9, There is neither research nor commentary on end-of-life services for patients within the mental health system.
Thus, this paper seeks to address this hiatus by presenting findings from a qualitative research project on end-of-life care for patients in a mental health institution called The Park, Centre for Mental Health, located in Brisbane, Queensland, Australia.
The Research Mindful of the lack of research on palliative care in a mental health setting, the principal aim of the research project was to document the experience of providing end-of-life care to patients for health care workers in an institutional mental health setting at TPCMH.
The work was carried out by a Central Queensland University post-doctoral research fellow with a background in palliative care research and infrastructure links to TPCMH.
Participants were verbally informed of their rights in research and written consent was obtained for participation in the research. The phenomenon in this case is the experience of providing terminal care for patients with a physical illness in an institutional mental health setting.
Descriptive phenomenology is particularly appropriate where little is known about a group of people 16,17 and so is well suited to the study of palliative care in a mental health facility where there is no previous research literature.
The experience of providing terminal care is documented through qualitative research using open-ended interviews conducted with health care workers at TPCMH by a post-doctoral fellow experienced in palliative care research.
Sample population The two qualitative strategies of purposive sampling and snowballing enrolments guided the selection of participants. Because of the legal issues associated with end-of-life care, research discussions with regards to any death at The Park is highly sensitive, or taboo in the case of a death presently under coronary inquiry.
Those involved in these two death were enrolled by snowballing techniques of targeting key people involved in the care of those patients and asking those participants of others who they would consider should be interview because of their significant role during the dying trajectory.
It is important to note that although a sample of eight is small, it is considered substantial in terms of the qualitative literature. The small number is directly related to the fact that there have been few recent deaths at The Park and so the overall target population is small and further reduced by the fact that only those deaths not under legal consideration can be targeted.
In view of such restrictions and the seminal nature of the work being undertaken, it was considered satisfying to be able to obtain a sample of eight. As there is no other work completed on palliative care and mental health, these interviews provide a unique opportunity to begin to place important end-of-life issues on the agenda.
Demographics Because of the sensitive nature of the topic under investigation and the fact that the interviews were completed in a closed institutional setting, extra precautions needed to be taken and promised to participants during informed consent procedures.
Such procedures were important in order to build a sufficiently safe environment where the interviewees could participate with confidence.
Thus, it is an ethical imperative that the information provided for demographics will need to be provided in generalities so that participants cannot be identified.
All of the participants had worked at The Park for a number of years, and some of the participants had very long work history at the institution, so all were well placed to understand the fullness of the issues in relation to their work place.
The participants were involved in nursing, care co-ordination, education and advocacy roles at the institution and were directly involved in the care of the two patients who had died within the last year and were no longer under coronary inquiry.
Data collection and analysis The time and location of the interviews were of the participants choosing. The interviews lasted for approximately one hour, and the interviews were conducted in interviewing rooms in the hospital.
The challenge in descriptive phenomenology is for the researcher to follow the ideas of participants rather than impose preformed assumptions on data collection The interviews were audio-recorded and transcribed verbatim.Supported by relevant theory, research, policy, and philosophy, this second edition of Psychiatric and Mental Health Nursing: The craft of caring provides a comprehensive overview of the practice of psychiatric and mental health nursing.
The concept of "the craft of caring" dictates that the basis of good nursing practice is a combination of both art and science, encouraging nurses to take a. Improve the health of your community. CSU has a dedicated degree for Indigenous people to develop key skills in mental illness detection and treatment, helping create positive outcomes for their community.
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The Philosophy and Science of Caring has four major concepts: human being, health, environment/society, and nursing.
Jean Watson refers to the human being as "a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self.
A mental health professional is a health care practitioner or community services provider who offers services for the purpose of improving an individual's mental health or to treat mental timberdesignmag.com broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the s to .
Keynote Speakers. Marc Brackett, Ph.D., is founding director of the Yale Center for Emotional Intelligence and Professor in the Child Study Center at Yale timberdesignmag.com grant-funded research focuses on: (1) the role of emotions and emotional intelligence in learning, decision making, relationship quality, and mental health; (2) the .