RESUMEN
OBJECTIVES: Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff. DESIGN: A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors. RESULTS: In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors. CONCLUSION: Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs. PROSPERO REGISTRATION NUMBER: CRD42022368155.
Asunto(s)
Arquitectura y Construcción de Instituciones de Salud , Personal de Salud , Pacientes Internos , Salud Mental , Adulto , Humanos , Atención a la Salud , Hospitales PsiquiátricosRESUMEN
OBJECTIVES: This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. BACKGROUND: There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. METHODS: Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. RESULTS: Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. CONCLUSION: This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.
Asunto(s)
Entorno Construido , Humanos , Arquitectura y Construcción de Instituciones de Salud/métodos , Arquitectura y Construcción de Hospitales/métodos , Hospitales Psiquiátricos/organización & administración , Trastornos Mentales/terapia , PrivacidadRESUMEN
The level of carer burden has increased as carers take on more responsibility for mental health consumers as a result of the contemporary shift in the delivery of services from institutional to community settings. Interventions are required to mitigate mental health carer burden. Therefore, we examined the association between dispositional gratitude and burden in a cross-sectional survey of 231 Australian mental health carers. Dispositional gratitude was assessed by the S-GRAT, and carer burden was measured using the Involvement Evaluation Questionnaire. The results of a general linear model demonstrated that higher levels of a lack of sense of deprivation were significantly associated with lower levels of tension, worrying and urging. In contrast, higher levels of simple appreciation were significantly associated with higher levels of supervision, worrying and urging. Our findings highlight that gratitude interventions should focus on promoting a lack of sense of deprivation and appreciation of others in order to reduce mental health carer burden.
Asunto(s)
Adaptación Psicológica , Cuidadores/psicología , Trastornos Mentales/enfermería , Trastornos Mentales/psicología , Estrés Psicológico , Adulto , Australia , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
BACKGROUND: Alpha-1 antitrypsin (AAT) is the most abundant circulating antiprotease and is a member of the serine protease inhibitor (SERPIN) superfamily. The gene encoding AAT is the highly polymorphic SERPINA1 gene, found at 14q32.1. Mutations in the SERPINA1 gene can lead to AAT deficiency (AATD) which is associated with a substantially increased risk of lung and liver disease. The most common pathogenic AAT variant is Z (Glu342Lys) which causes AAT to misfold and polymerise within hepatocytes and other AAT-producing cells. A group of rare mutations causing AATD, termed Null or Q0, are characterised by a complete absence of AAT in the plasma. While ultra rare, these mutations confer a particularly high risk of emphysema. METHODS: We performed the determination of AAT serum levels by a rate immune nephelometric method or by immune turbidimetry. The phenotype was determined by isoelectric focusing analysis on agarose gel with specific immunological detection. DNA was isolated from whole peripheral blood or dried blood spot (DBS) samples using a commercial extraction kit. The new mutations were identified by sequencing all coding exons (II-V) of the SERPINA1 gene. RESULTS: We have found eight previously unidentified SERPINA1 Null mutations, named: Q0cork, Q0perugia, Q0brescia, Q0torino, Q0cosenza, Q0pordenone, Q0lampedusa, and Q0dublin . Analysis of clinical characteristics revealed evidence of the recurrence of lung symptoms (dyspnoea, cough) and lung diseases (emphysema, asthma, chronic bronchitis) in M/Null subjects, over 45 years-old, irrespective of smoking. CONCLUSIONS: We have added eight more mutations to the list of SERPINA1 Null alleles. This study underlines that the laboratory diagnosis of AATD is not just a matter of degree, because the precise determination of the deficiency and Null alleles carried by an AATD individual may help to evaluate the risk for the lung disease.
Asunto(s)
Pulmón/fisiopatología , Mutación , Inhibidores de Serina Proteinasa/genética , Deficiencia de alfa 1-Antitripsina/genética , alfa 1-Antitripsina/genética , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Deficiencia de alfa 1-Antitripsina/fisiopatologíaRESUMEN
Heart transplantation is now routinely offered as a treatment for end-stage heart failure, and the "gift-of-life" metaphor has become pervasive in this context, forming the foundation on which transplantation discourses rest. In this article, we question organ-as-gift understandings of transplantation. One can also legitimately think of the transplanted organ as a donation, with distinct implications in terms of the transplantation experience for the recipient. We explored the transplantation experience of 13 heart recipients in Australia. We conducted semistructured interviews, and our interpretative phenomenological analysis of the data resulted in three themes: deservingness, nuances of gratitude, and giving forward. Our results indicate that differences between organ-as-gift and organ-as-donation understandings of transplantation are more than merely semantic. Organ-as-donation understandings raise the issue of deservingness, with recipients' assessments of their worthiness influencing their posttransplant experience of gratitude and, ultimately, the meaning(s) gleaned from their transplant experiences.
Asunto(s)
Altruismo , Actitud Frente a la Salud , Donaciones , Trasplante de Corazón , Adulto , Anciano , Toma de Decisiones , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Motivación , Satisfacción Personal , Calidad de Vida , Australia OccidentalRESUMEN
BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) results from mutations in the SERPINA1 gene and classically presents with early-onset emphysema and liver disease. The most common mutation presenting with clinical evidence is the Z mutation, while the S mutation is associated with a milder plasma deficiency. AATD is an under-diagnosed condition and the World Health Organisation recommends targeted detection programmes for AATD in patients with chronic obstructive pulmonary disease (COPD), non-responsive asthma, cryptogenic liver disease and first degree relatives of known AATD patients. METHODS: We present data from the first 3,000 individuals screened following ATS/ERS guidelines as part of the Irish National Targeted Detection Programme (INTDP). We also investigated a DNA collection of 1,100 individuals randomly sampled from the general population. Serum and DNA was collected from both groups and mutations in the SERPINA1 gene detected by phenotyping or genotyping. RESULTS: The Irish National Targeted Detection Programme identified 42 ZZ, 44 SZ, 14 SS, 430 MZ, 263 MS, 20 IX and 2 rare mutations. Analysis of 1,100 randomly selected individuals identified 113 MS, 46 MZ, 2 SS and 2 SZ genotypes. CONCLUSION: Our findings demonstrate that AATD in Ireland is more prevalent than previously estimated with Z and S allele frequencies among the highest in the world. Furthermore, our targeted detection programme enriched the population of those carrying the Z but not the S allele, suggesting the Z allele is more important in the pathogenesis of those conditions targeted by the detection programme.
Asunto(s)
Deficiencia de alfa 1-Antitripsina/epidemiología , Distribución de Chi-Cuadrado , Análisis Mutacional de ADN , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Encuestas Epidemiológicas , Humanos , Irlanda/epidemiología , Tamizaje Masivo/métodos , Mutación , Oportunidad Relativa , Fenotipo , Prevalencia , Medición de Riesgo , Factores de Riesgo , alfa 1-Antitripsina/genética , Deficiencia de alfa 1-Antitripsina/diagnóstico , Deficiencia de alfa 1-Antitripsina/genéticaRESUMEN
Forehead blood flow was monitored in seven participants with a unilateral facial nerve lesion during relaxation, respiratory biofeedback and a sad documentary. Vascular waves at 0.1Hz strengthened during respiratory biofeedback, in tune with breathing cycles that also averaged 0.1Hz. In addition, a psychomotor rhythm at 0.15Hz was more prominent in vascular waveforms on the denervated than intact side of the forehead, both before and during relaxation and the sad documentary. These findings suggest that parasympathetic activity in the facial nerve interferes with the psychomotor rhythm in the forehead microvasculature.