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Biomedical subjects

K Gournay

Publications and source records attributed to K Gournay.

At least 19 recordsLinked to original sources
PubMed2000

Beliefs about voices and their effects on coping strategies.

Cognitive behavioural techniques are increasingly used as adjuncts to medication in the treatment of auditory hallucinations for people with schizophrenia. There are now literally hundreds of nurses trained in the use of cognitive behavioural interventions for psychosis. However, there is still disagreement about the nature of the cognitive processes that lead to deficits or biases in patients' processing of information about their psychotic experiences. Using Chadwick & Birchwood's Beliefs About Voices Questionnaire (BAVQ), the investigator collected data regarding voices from a sample of men and women being treated for schizophrenia by secondary mental health services. The investigator then carried out a cross-lagged panel analysis of the data. The investigator found, as predicted, positive relationships between a resistive coping style and an attribution of malevolence to voices, and between an engaging coping style and an attribution of benevolence to voices. Coping and attributional styles were not necessarily stable over time. There was a non-significant difference between women's and men's attributions and coping styles. There was less fluctuation over time in the women's scores on the BAVQ. This research shows that one cannot assume that either coping or attributional style becomes more stable over time. However, while there are strong relationships between attributions and coping styles, and particularly between malevolence and resistance and benevolence and engagement, these relationships are not necessarily mutually exclusive and some people in the study believe their voices to be both malevolent and benevolent. These findings suggest that clinicians need to make a very careful assessment of attribution and coping with regard to hallucinations and that systematic reassessment is very important. Further research is necessary in both the phenomenology of attribution and coping, but also to relate these variables to other aspects of schizophrenic illnesses.

Adaptation, Psychological↗
PubMed2000

Suicide and self-harm in in-patient psychiatric units: a study of nursing issues in 31 cases.

A significant number of incidents of suicide and self-harm occur whilst patients are in receipt of care as in-patients. This audit comprises 31 cases which were referred to the first author for expert opinion, each case being the subject of legal action brought by patients and/or their families. The cases were referred from 31 different NHS trusts across England. All concerned suicide/serious self-harm in people in receipt of in-patient care. The aims of this audit were to carry out a detailed assessment of the 31 individual cases, so as to provide a nursing dimension to already established enquiries in this area and also to examine whether specific issues might be the subject of more systematic research. Further, this paper aims to provide some insights in the area of litigation, where nurses are becoming increasingly involved. The same broad approach to information-gathering and analysis was used, comprising a systematic review of case records, trust policies, expert reports and, where appropriate, inquest transcriptions. The sample comprised 12 suicides and 19 cases of serious self-harm. Factors associated with these events include: being male, having a dual diagnosis of mental illness and drug/alcohol abuse, and age between 21 and 30 years. Of the 12 deaths, five occurred in hospital, four by hanging and one by drowning. The audit highlighted environmental factors associated with these events which, arguably, could be simply addressed. There was a considerable variation in the content and quality of observation policy and practice. The results of this audit point to the need for further research but, above all, provide evidence requiring urgent action by the Department of Health regarding the setting of national standards.

Adult↗
PubMed1999

Psychiatric nursing in prison: the state of the art?

Psychiatric nursing in prisons has received criticism from within and outside the profession in recent years. In England and Wales this amongst other issues has prompted a review of forensic health care by the United Kingdom Central Council for Nursing, Midwifery & Health Visiting (UKCC). The status of forensic psychiatric nursing as a specialty has also been disputed in the literature and the role of nurses working in this field is seen by some to be more about social control than caring. These arguments are set in the present situation of increasing numbers of mentally ill individuals in the prison system and a crisis in the availability of beds in secure units, a situation that is paralleled throughout the western world. The standard expected of health care services in prisons is equivalence with the service the public receives from the National Health Service (NHS). The number of prisoners needing transfer to hospital has increased during the last decade, resulting in competition for a limited number of suitable beds. The effect on health care centres (HCCs) in English prisons is that they now must provide long-term care for seriously mentally ill prisoners. This paper outlines the development of British psychiatric services in prisons. It then describes the HCC in Her Majesty's prison (HMP) Belmarsh and reports on recent radical changes in the management structure of this service. The aim of these changes is to produce a clinical environment in which psychiatric nurses can deliver high quality care in an area beset with difficulties for clinicians and managers and to further progress towards the goal of equivalence. These advances have been achieved through a shift of emphasis in management structure that increases the number of clinical posts and minimizes administrative and security-based responsibilities held by clinical grades. We conclude that although external contracts are necessary, much can be achieved through internal review and changes in policy.

England↗
PubMed1999

A national survey of practice nurse involvement in mental health interventions.

BACKGROUND: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. AIM: This study aimed to quantify practice nurses' involvement in delivering mental health interventions in primary care settings. METHOD: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non-eligible respondents were removed an adjusted response rate of 54% was achieved. RESULTS: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side-effects were infrequently monitored and PNs' understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. CONCLUSIONS: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.

Adult↗
PubMed1999

Training for the mental health workforce: a review of developments in the United Kingdom.

OBJECTIVE: Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia. METHOD: A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation. RESULTS AND CONCLUSIONS: A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive-behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.

Evidence-Based Medicine↗
PubMed1997

Dual diagnosis of severe mental health problems and substance abuse/dependence: a major priority for mental health nursing.

It is now established that very significant numbers of people with severe mental illness abuse or depend on drugs and/or alcohol. This combination (Dual Diagnosis) leads to increased rates of violence and service use, a reduction in adherence to treatment regimes, an increase in susceptibility to human immunodeficiency virus (HIV) infection and is now found in in-patient populations. Because of their vulnerability to accidents and physical illnesses, dual diagnosis patients are found increasingly in accident and emergency departments, general medical wards and primary care settings. For this reason nurses and other health professionals working in general hospitals should be as aware as their mental health colleagues of the specific needs of this population. There are some excellent models of service organization and training for dealing with dual diagnoses populations in some parts of the USA. However, there is little such development in the UK. There are clear pathways to be followed, but the need for action is urgent.

Humans↗
PubMed1997

Pulling together: multi-disciplinary training for mental health nursing.

In 1995 the Sainsbury Centre for Mental Health commissioned a major review of all specialist mental health training. The current, largely uni-disciplinary approach to training was felt to be failing to equip professionals with the necessary skills for today's multi-disciplinary, integrated, community-based service, where users and their carers expect an equal partnership and sharing of information. Kevin Gournay and Susannah Strong outline the findings and recommendations of the review, and its implications for mental health nurse education, which make a case for its separation from the rest of the nursing profession.

Certification↗
PubMed1996

Body dysmorphic disorder: a cognitive behavioural model and pilot randomised controlled trial.

A cognitive behavioural model of body image is presented with specific reference to body dysmorphic disorder (BDD). We make specific hypotheses from the model for testing BDD patients in comparison with: (i) patients with "real" disfigurements who seek cosmetic surgery; (ii) subjects with "real" disfigurements who are emotionally well adjusted; and (iii) healthy controls without any defect. There have been no randomised controlled trials of treatment for BDD and therefore the model has clear implications for the development of cognitive behavioural therapy. This was evaluated in a pilot controlled trial. Nineteen patients were randomly allocated to either cognitive behaviour therapy or a waiting list control group over 12 weeks. There were no significant pre-post differences on any of the measures in the waiting list group. There were significant changes in the treated group on specific measures of BDD and depressed mood. Cognitive behaviour therapy should be further evaluated in a larger controlled trial in comparison with another psychological treatment such as interpersonal therapy and pharmacotherapy.

Adult↗
PubMed1996

Schizophrenia: a review of the contemporary literature and implications for mental health nursing theory, practice and education.

Contemporary research in the aetiology, neuropsychology and epidemiology of schizophrenia is reviewed. The picture coming from this work is a group of brain diseases of neurodevelopmental origin which manifest themselves in a variety of ways. In turn, there are a range of cognitive deficits associated with the schizophrenias which may, in the extreme, produce major functional handicap. This new knowledge has obvious implications for nurse education and a priority is to place this in undergraduate programmes. However, more importantly, it is argued that we need to alter conceptual frameworks. for example, in some cases we should care for people with schizophrenia in the same way as one would care for an individual suffering the after-effects of a head injury. In the more severe forms of the illness we should take into account the probability that our patients may have significant problems of memory and attention, and thus modify interventions accordingly. It seems clear that our current nursing theories are not underpinned by relevant knowledge of the nature of schizophrenia and this problem warrants urgent attention.

Humans↗
PubMed1996

Body dysmorphic disorder. A survey of fifty cases.

BACKGROUND: Body dysmorphic disorder (BDD) consists of a preoccupation with an 'imagined' defect in appearance which causes significant distress or impairment in functioning. There has been little previous research into BDD. This study replicates a survey from the USA in a UK population and evaluates specific measures of BDD. METHOD: Cross-sectional interview survey of 50 patients who satisfied DSM-IV criteria for BDD as their primary disorder. RESULTS: The average age at onset was late adolescence and a large proportion of patients were either single or divorced. Three-quarters of the sample were female. There was a high degree of comorbidity with the most common additional Axis l diagnosis being either a mood disorder (26%), social phobia (16%) or obsessive-compulsive disorder (6%). Twenty-four per cent had made a suicide attempt in the past. Personality disorders were present in 72% of patients, the most common being paranoid, avoidant and obsessive-compulsive. CONCLUSIONS: BDD patients had a high associated comorbidity and previous suicide attempts. BDD is a chronic handicapping disorder and patients are not being adequately identified or treated by health professionals.

Adult↗
PubMed1995

Mental health nurses working purposefully with people with serious and enduring mental illness--an international perspective.

There has been a world-wide refocus on people with serious and enduring mental health problems. This has provided major challenges for all those involved in mental health care, as the last two decades have produced radical changes in service delivery and a range of new interventions. Mental health nurses are playing a central role as community based clinical case managers and are beginning to use a range of psychosocial interventions. They are also revitalizing skills in the more traditional areas of medication management and residential care. In addition, there are growing problems of substance abuse and violence which needs to be addressed. Mental health nursing is responding in this new era by various training initiatives. However, these programmes need rapid expansion as mental health nurses will continue to play a key role in the services of the future and therefore need these new skills.

Behavior Therapy↗
PubMed1995

The community psychiatric nurse in primary care: an economic analysis.

Community psychiatric nurses (CPNs) in the United Kingdom are increasingly working in primary health care settings with less serious mental health problems. This paper describes an economic evaluation of their work using a randomized controlled trial in which 231 patients were assigned to continuing general practitioner care or one of two conditions of CPN intervention. This is only the third systematic economic analysis of community mental health nursing in the UK and the first carried out by mental health nurses. Various costs to patients, their families and the health care system were determined. Results showed that patients receiving CPN intervention experienced less absence from work and that this resulted in a net benefit. However, the cost per quality adjusted life year for intervening with this group of patients was probably several times more than for intervening with the seriously mentally ill. Therefore, if one considers both the clinical and economic results of the study, taken together with the recent results of the review of mental health nursing, there seems little justification for CPNs continuing to work in this area.

Absenteeism↗