Depression and anxiety are prevalent in the stroke population and can have a significant impact on the patient and their family's long-term outcomes, however the screening for these conditions does not meet best practice recommendations. To address this deficit, this study developed "Post-Stroke Mood Assessment Pathways" and embedded them into practice by utilising the PARiHS framework (for the implementation of evidence-based practice), in conjunction with staff training. The study examined the rates of mood screening, clinical interviews, and completion of interventions for stroke patients through a retrospective chart audit (n = 213) one year prior to, and one year post-implementation (n = 238) of the pathways. The data show statistically significant increased documentation around mood screening and clinical interview 95% CI [4.86, 19.88]
This paper presents evidence on the relationship between physical disability and risk for psychological distress and disorder. Data were obtained from a large and representative sample of physically disabled persons resident in the community and from nondisabled comparison subjects matched in age, sex, and area of residence. Distress was assessed in terms of depressive symptomatology (measured by the CES-D), anxiety (measured by a modification of Speilberger's State Anxiety Scale), and major depressive disorder (estimated by the DIS). Disabled individuals were found to be at substantially elevated risk for anxiety, for depressive symptoms, and for major depressive disorder. These results also suggest that more severely disabled individuals exhibit higher levels of psychological distress. It is argued that these findings can most plausibly be attributed to chronic stress that tends to characterize the life circumstance and experience of disabled individuals.Physical disability has been defined by the World Health Organization (W.H.O.) (1976) as "an existing difficulty in performing one or more activities which, in accordance with a person's age, sex, and normative social role, are generally accepted as essential components of daily living, such as self-care, social relations, and economic activity." It thus implies a condition characterized by diminished capacity to perform social and occupational roles and, therefore, to meet personal needs and achieve related satisfactions. As Vargo (1978) has noted, the physical rehabilitation process following the onset or occurrence of disability, while very important, is also relatively short, with most individuals achieving maximum physical recovery within one year. In contrast, rehabilitation in the broader sense is a life-long task and struggle. Given the nature of physical disability, it is not difficult to understand the widely held assumption that physical disability increases risk for psychological maladjustment. Presumably, the elevated difficulty in performing social and occupational roles that tends to be experienced by disabled individuals constitutes a significant source of enduring stress that challenges adaptive capacities.
This paper discusses how the concepts of hope and hopelessness can affect therapeutic interventions when working with people affected by cancer. The concepts of hope and hopelessness are considered within the therapeutic relationship and the biomedical model. This explores whether there is a difference between hope and denial and considers how culture, religion, and spirituality influence an individual's interpretation of hope. For some people living with a cancer diagnosis, the word ‘hope’ can become a burden. They can feel a pressure to present as strong, positive, and hopeful in the face of extremely confronting situations. Therapists need to give patients time and space to explore their feelings of hopelessness without rushing them to a place of hope for which they are not ready. Case examples are provided and the author reflects upon her own family therapy practice working in an acute health care facility. This stresses the importance of critical reflection, supervision, and peer support.
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