Peer Support Amongst Mental Health Patients on Psychiatric Wards: An Untapped Resource for Recovery Catherine Pugnaire Gros, RN, MSc(A) Assistant Professor,

Peer Support Amongst Mental Health Patients on Psychiatric Wards:

An Untapped Resource for Recovery

Catherine Pugnaire Gros, RN, MSc(A) Assistant Professor, McGill University School of Nursing, Nurse Clinical Specialist, Douglas InstituteMarjorie Montreuil, RN, MSc(A) Staff Nurse

Lindsay Bouchard, RN, MSc(A) Staff Nurse27e Colloque AQIISM; Levis, Qc, le 4 juin, 2010

Catherine Pugnaire Gros, RN, MSc(A) Assistant Professor, McGill Univ. School of Nursing Nurse Clinical Educator, Douglas Mental Health University Inst

Marjorie 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

MELS Bursary, Québec Ministry & McGill University Research Bursary, Nursing Directorate,& Douglas Institute Foundation•Helene Racine, DSI, 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

Acknowledgements

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

• improved physiological and functional status

• decreased emotional & psychological distress

• improved symptom resolution

• decreased blood pressure

• decreased anxiety

• decreased depression

• increased self-worth

• increased patient satisfaction

(Stewart, 2003, Pless,1994)

The McGill Model of Nursing & Collaborative, Strengths-Based Care:

An Evidence-Based Approach Client Health Outcomes

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

•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?

Peer Support Amongst Mental Health Patients: What’s the Evidence?

Call for research

Research Question: What are

the perceptions & experiences 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

SupportiveGestures, Actions

Reported Outcomes

Support Providers

Support Recipients

1. Offering material goods

2. Helping with ADLs

3. Sharing a social life

4. Providing emotional care & encouragement

5. Offering advice & information

1. Improved emotional state

2. More positive outlook perspective

3. Positive changes in behavior

1. Receiving recognition, appreciation

2. Increased Motivation

3. Developing friendships

4. Increased sense of well-being

Thinking about

peers…

The Process of Peer Support

Observing,

Noticing, Reflecting…

Thinking about

peers…

The Process of Peer Support

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….”

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

Supportive Gestures or Actions

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.”

“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.”

Offering advice, Sharing information

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 deserves another.”

…..

“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

and

Continue

Building

Bridges…

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 client-centered 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.