Peer Support Amongst Mental Health Patients on
Psychiatric Wards:
An Untapped Resource for Recovery
Catherine Pugnaire Gros, RN, MSc(A) Assistant Professor, McGill Univ. School of Nursing
RN, MSc(A)
Assistant
Professor,
McGill Catherine
UniversityPugnaire
School ofGros,
Nursing,
Nurse Clinical
Specialist,
Douglas Institute
Marjorie Montreuil, RN, MSc(A) Staff Nurse
Lindsay Bouchard, RN, MSc(A) Staff Nurse
27e Colloque AQIISM; Levis, Qc, le 4 juin, 2010
Marjorie
Nurse Clinical Educator, Douglas Mental Health University Inst
Montreuil, RN, MSc(A) Staff Nurse; Lindsay Bouchard, RN, MSc(A) Staff Nurse
Promoting Nursing’s Future: Building Bridges from Classrooms to Clinical
Settings
FAHC 2nd Annual Nursing Research & Evidence-Based Practice Symposium Burlington, Vermont
November 6, 2010
Acknowledgements
MELS Bursary, Québec Ministry &
McGill
University
Research Bursary, Nursing
Directorate,&
Douglas
InstituteDSI,
Foundation
•Helene Racine,
Douglas Mental Health University Institute
•Dr. Margaret Purden, School of Nursing McGill University
•Head Nurses: I. Winkelmann, A. Saadi, D. Paquin, B. Maréchal
•Staff Nurses
•Patient Participants
Special thanks:
Dr. Hollie Shaner-McRae, RN
for the bridges you build…
Study purpose and objectives
To advance the practice and development of collaborative,
strengths-based nursing by applying theory & evidence to clinical
practice in tertiary care hospital settings
To gain insight into the strengths & capacities of hospitalized
patients
To acquire new knowledge in a previously unexplored area of
patient care
To generate evidence for future nursing initiatives aimed at
promoting patient recovery through peer support
The McGill Model of Nursing & Collaborative, Strengths-Based Care:
An Evidence-Based Approach
Client Health Outcomes
•
decreased anxiety
•
decreased depression
decreased emotional &
psychological distress
•
increased self-worth
•
improved symptom resolution
•
increased patient satisfaction
•
decreased blood pressure
•
•
improved physiological and
functional status
(Stewart, 2003, Pless,1994)
Professional Outcomes
Increased Clinician Satisfaction
The most important determinant of clinician satisfaction is the clinician-patient
relationship
(Suchman, 1993; Tamblyn, 2007)
Caring for mental health patients in hospital
settings remains an important challenge!
Despite the ongoing shift toward community-based
care:
An estimated 190,000 Canadians are hospitalized annually
for the treatment of mental illnesses
Canadian Institute for Health Information (CIHI), 2008.
Mental Health Patients in Hospital Settings: A Day in the Life
Hospitalized patients on psychiatric units have ample time
& ongoing opportunities for interaction
• The average length of stay for hospitalized mental health
patients: 100 days. Canadian Institute for Health Information (CIHI), 2008.
• Hospitalized patients experience intense intimacy through within
a shared living & healing environment
•Continuous peer contact: 24/7
• Over an extended period
• During a critical time of transition: illness, admission,
diagnosis, treatments, discharge…
Peer Support Amongst Mental Health Patients:
What’s the Evidence?
•Peer support is beneficial for persons with mental
Illness (Solomon, 2004; et al.)
•Peer support plays an important role in patient
recovery (Coatsworth et al., 2006; Topor et al., 2006; Verhaeghe et al., 2008).
However…
Peer Support Amongst Mental Health Patients:
What’s the Evidence?
Current research on peer support during mental illness focuses
exclusively on out-patients
No research has been conducted on peer support amongst
psychiatric in-patients
At the same time…
Clinical observations & experiences of Nurses & Nursing
Students have recognised the existence of peer support on
in-patient units….
So…
Call for research
Research Question:
the perceptions & experiences
What are
of
peer support amongst adults
hospitalized on in-patient mental health units?
A working definition of Peer Support:
• Interactions between or amongst patients:
• Naturally occurring; spontaneous
• Perceived as “helpful” , “supportive”
• Includes giving &/or receiving “support”
(Davidson et al., 1999; Mead, Hilton, & Curtis, 2001; Dennis,
2003)
Study Purpose:
To explore patient perceptions & experiences related to
giving and/or receiving peer support
Research Design & Methods:
• In-depth, semi-structured interviews
• Conducted with individual patients
• Audio taped & transcribed verbatim
• Content analyzed using a qualitative, descriptive design
(Thorne, et al, (1997)
Study Sample:
• 10 in-patients; 6 men + 4 women
•Age range: 26-64 years (mean=47 years)
• Diagnosed with a mental illness:
depression (2), schizophrenia, (6); atypical psychosis (2)
•Currently hospitalized on an in-patient treatment unit:
• General Psychiatry; (acute care, short-stay units)
• Severe & Persistent Disorders unit
• Forensic Psychiatry & Intensive Rehabilitation unit
•Mean length of hospital stay at time of interview: 72 days
Results
Offering & receiving peer support
is a complex phenomenon that
occurs regularly & spontaneously
amongst men & women during
psychiatric hospitalization
Offering peer support is a deliberate
process involving observation, reflection,
taking action & evaluating outcomes
Peer support is present across in-patient settings:
•Acute care, short term units
•Longer stay, rehabilitation & forensic units
The Process of Peer Support
Thinking
about
peers…
SupportiveG
estures,
Actions
1. Offering material
goods
2. Helping with ADLs
Observing,
Noticing,
Reflecting…
Reported
Outcomes
Support
Support
Providers Recipients
3. Sharing a social
life
4. Providing
emotional care &
encouragement
5. Offering advice &
information
1. Receiving
recognition,
appreciation
1. Improved
emotional
state
2. Increased
Motivation
2. More positive
outlook
perspective
3. Developing
friendships
4. Increased
sense of
well-being
3. Positive
changes in
behavior
The Process of Peer Support
Thinking
about
peers…
Observing, Noticing, Reflecting…
“I believe in helping and witnessing, seeing what
you see, in another patient … we notice, you
know, pay attention to what’s going on.”
“I see that he’s all alone; and think that he just
needs someone to talk to….”
Supportive Gestures or Actions
1. Offering material goods
2. Helping with basic care & daily needs
3. Sharing a social life
4. Providing emotional care & encouragement
5. Offering advice & information
Sharing material goods
“I gave to people. I gave lunches, I
gave cigarettes … it can be anything–
a piece of clothing, a word… anything.”
Assisting with basic care & daily needs
“I try to tell him to get up. Because there are
many
patients … who are not getting up to eat,
they
stay in their beds. So we try to
stimulate people.”
…..
“When he [an older patient] is sitting in his
chair
and he wants to get up, I put my
hand under his
arm, and I help him get up.”
Sharing a social life
“We enjoy getting food
and eating that together …
We talk a lot, we all joke.”
……
Providing emotional support, encouragement
“I talk [to another patient] about my problems, the
choices I made in the past that I regret, and about
my impression of having no future… He always
tries to make me see the positive side of life.”
Offering advice, Sharing information
“So he [another patient]
gave me some ideas;
some
paths of reflection. A little
like the nurses do, but
the patients do it also
between each other.”
……..
“I saw [another patient], she doesn’t talk much.
I go, ‘why don’t you get a radio and listen to
some music. It will distract you.’
She did it, bought a radio, and she’s a little
better.”
Outcomes for peer support recipients
• Better emotional state
• Improved outlook on current situation
• Positive behavioral changes
“I tell her: ‘What is it that you wanted to finish saying?
And what do you want to explain?’ And I try to see
what she wants to say; what she’s trying to make me
understand, or to make others understand … [Now]
she talks a little more, she’s starting to add a bit more
words to her sentences.”
Health outcomes for peer support recipients
• Improved emotional state; feeling less alone, less anxious, less
stressed
• Improved outlook on current situation
“ [I have] A better understanding of my situation…[I feel] more in
control”
• Positive behavioral changes
• Greater participation in group activities
• Adopting healthy lifestyle choices
“He invites me to take walks outside; [something] I wouldn’t
want to do by myself”
Health outcomes for peer support recipients
• Improved Functioning
“I tell her: ‘What is it that you wanted to finish saying? And what
do you want to explain?’ And I try to see what she wants to
say; what she’s trying to make me understand, or to make
others understand … [Now] she talks a little more, she’s
starting to add a bit more words to her sentences.”
Outcomes for Support Providers
“I feel good … I think it’s
in my nature … I try to help
them a little bit … I feel good.
I like helping others.”
…..
“I can be a good ear for him [another patient], I think
that it’s a beautiful gift, a good bonus in my day.”
…..
“[We would] reminisce, talk about different things …
You felt happy … The friendships I made here helped a
lot.”
Context of Peer Support
• Patient characteristics
– Traits, skills, experiences can encourage peer support
“[Another patient] understood what I was going
through, because she went through it herself.”
– Can give & receive peer support despite mental illness
“It always makes me feel good to look after
somebody. Even if I’m sick myself, and I do it.”
“Even if they [other patients] have problems, you have
to help them.”
Context of Peer Support
• Group dynamics
“One good turn
another.”
deserves
…..
“There are little [cliques] in the group. But
there’s still a good team spirit…Good friendships
are formed here.”
Context of Peer Support
• Staff attitudes & Beliefs
Little or no recognition of peer support;
limited knowledge & understanding
of health benefits
Focus on risks & patient vulnerabilities
As a result:
Health care interventions are geared toward protecting
patients from possible harmful outcomes
“[The nurse] told me: ‘…Don’t help him
[another patient], he’s not going to help you.’ ”
Discussion
• Previous research highlights patient deficits such as the
limited social skills for persons with depression (Tse & Bond,
2004) or schizophrenia (Couture et al., 2006; Peljert et al., 1995).
• This study challenges those ideas; suggesting that peers
offer a unique form of support that health professionals or
others cannot provide.
Hospitalized peers contribute to patient care &
recovery in many important & unique ways
• Peer support works in tandem with nurisng
support; Complementing the care offered by
health professionals .
•Natural caregiving partnerships exist between
Nurses & hospitalized patients!!
Conclusions
• Study findings favor the application to practice of
collaborative, strengths based nursing care,
consistent with approaches such as Recovery & the
McGill Model of Nursing.
• These approaches focus on the strengths & self-care
capacities of clients & families who are viewed as
experts; responsible for their own health & well
being. (Allen, et al, 2002; Gottlieb,et al. 2005, Gros et al 2007) .
•
Clinical Implications & Practice Recommendations
• Refocus nursing interventions on collaborative processes
aimed at developing care-giving partnerships with clients &
families
Recognize & Facilitate peer support by:
• Exploring, identifying, & reinforcing the means by which
hospitalized patients offer & receive support from one
another.
Clinical Implications & Practice Recommendations
– Acknowledge & recognize the essential role that hospitalized patients play in
their own recovery as well as in the health & recovery of others.
– Be a “Strengths Detective”! Learn from patients by observing, listening &
searching for strengths & competencies
– Be an expert witness. Reflect observations related to positive & supportive
interactions to occur amongst patients
– Highlight gestures of support offered to & received by peers & work in
partnership to explore & evaluate the resulting outcomes & benefits
– Celebrate together with patients the positive outcomes of peer support
Amongst Patients
Between Patients & Staff
From Classrooms to Clinical Settings
From Nursing Research to Nursing Practice…
References
•
Allen, M & Warner, M. (2002). “A Developmental Model of Health and Nursing”. Journal
of Family Nursing, vol 8, 2002, p. 96-135
•
Bouchard, L., M. Montreuil, & C. Gros (2010). Peer support among inpatients in an adult
mental health setting. Issues in Mental Health Nursing, 31, 589-598.
•
Gottlieb, L. N., Feeley, N., with Dalton, C. (2005). The Collaborative Partnership
Approach to Care: A Delicate Balance. Toronto, ON: Elsevier-Mosby.
•
Gros, C. P., & Young, L. (2007). “Teaching the McGill Model of Nursing and clientcentered care: Collaborative strategies for staff education and development”. In L. E.
Young & B. L. Patterson (Eds.), Teaching Nursing: Developing a Student Centered
Learning Environment Philadelphia: Lippincott, Williams & Wilkins. p.190-221.
•
Dennis, C. L. (2003). Peer support within a health care context: A concept analysis.
International Journal of Nursing Studies, 40, 321–332.