The consultative process used in outreach : a narrative account

Aim The aim of this paper was to provide a narrative account of the communication skills used in an effective outreach consultation utilizing Neighbour’s consultative model. Other consultation models were considered; however, because of their overly comprehensive approach or emphasis on behaviour modification, these were deemed inappropriate. Background The nursing profession has endured significant changes of late and as a result is developing more autonomous roles in both the community and the acute health care settings. In the past, the term consultancy was used within the medical context; nowadays, there are advance nurse practitioners for whom consultancy is an integral part of their role. Although every nursing interaction is in essence a consultation, the fact that nurses are taking up on new advanced roles highlights the necessity for nurses to develop their consultation skills even further. Therefore, it makes sense to explore what aspects of that consultancy role needs special consideration in order to ensure that positive outcomes are achieved. Conclusions This paper has used a narrative account to uncover those salient skills needed to enhance the therapeutic relationship with a patient requiring the services of outreach. Furthermore, the application of a recognized consultation model was used to elucidate the underpinning knowledge of systematic history taking and assessment as well as demonstrating the communication skills and strategies needed to increase the patient’s participation and empowerment throughout the consultation. Relevance to clinical practice Effective communication skills encompassed in a consultative model are integral to the success in safeguarding the well-being of patients requiring advanced levels of care. Prejudging or pre-empting information being conveyed can be detrimental to patient safety and may prolong or complicate treatment plans.

The little child in our great cities : a narrative account of original work for the health of the pre-school child in twenty-four cities of the United States /

Mode of access: Internet.

History of St. Paul and vicinity : a chronicle of progress and a narrative account of the industries, institutions, and people of the city and its tributary territory /

Index: vol. 1, p. xix-xxxvii.

Guide to questioning children during the free-narrative phase of an investigative interview

The inability of professionals to maintain the use of open-ended questions in the free-narrative phase of investigative interviews with children has been a major problem around the globe. The current paper addresses this concern by describing the key principles underlying the elicitation of free-narrative accounts and practical suggestions for formulating questions. The paper focuses on interviewing children in the early- and middle-childhood years and commences with a definition of the term “free-narrative account” and a description of how such accounts typically develop in children. A description is then provided of the four key characteristics of a good question in the free-narrative interview phase. These include (a) simple language, (b) absence of specific details or coercive techniques, (c) flexibility on the part of the interviewee to choose what details will be reported, and (d) encouragement of an elaborate response. Finally, the process of eliciting a narrative account is briefly described, including examples of questions that adhere to the four characteristics listed above.

Does the cognitive interview promote the coherence of narrative accounts in children with and without an intellectual disability?

We examined whether the cognitive interview (CI) procedure enhanced the coherence of narrative accounts provided by children with and without intellectual disabilities (ID), matched on chronological age. Children watched a videotaped magic show; one day later, they were interviewed using the CI or a structured interview (SI). Children interviewed using the CI reported more correct details than those interviewed using the SI. Additionally, children interviewed using the CI reported more contextual background details, more logically ordered sequences, more temporal markers, and fewer inconsistencies in their stories than those interviewed using the SI. However, the CI did not increase the number of story grammar elements compared with the SI. Overall children interviewed with the CI told better stories than those interviewed with the SI. This finding provided further support for the effectiveness of the CI with vulnerable witnesses, particularly children with ID.

The silence and the silencing of the nurse's voice : a reading of patient progress notes

Content analysis of text offers a method for exploring experiences which usually remain unquestioned and unexamined. In this paper the authors analyse a set of patient progress notes by re-framing them as a narrative account of a significant event in the experience of a patient, her family and attending health care workers. Examination of these notes provides insights into aspects of clinical practice which are usually dealt with at a taken-for-granted level. An interpretation of previously unexamined therapeutic practices within the social and political context of institutional health care is offered.

The Far Eastern Question at the Washington Conference (1921-1922) with an outline of its implications for internal politics in China

This dissertation is a narrative account of the negotiations concerning the question of the Far East and the Shandong issue at the Washington Conference, leading to treaties, agreements and resolutions. In this dissertation, a certain stress is laid on the interaction between the Conference and the internal situation in China, particularly concerning the question of the implications of the Conference for Cabinet politics in Peking. Through the narrative account of the Conference, the general aim is an attempt to reassess the achievements of the Washington Conference. Too often the Washington Conference has been viewed negatively. The political aim behind the legal framework was to open the door to China as a sovereign State member of the international community whose territorial integrity was internationally recognized, despite its chaotic internal situation. It is undeniable that the Washington Conference opened a new chapter in modern Chinese history. The violations of the agreements concerning China that occurred in the 1930s should not lead to the belief that these agreements were of no value. Peace may not be lasting and evolves according to circumstances; agreements are transitory, and new situations need new arrangements. This dissertation tries to demonstrate that the agreements in themselves were not the cause of their failure, but the failure was due to the lack of determination on the part of the Signatories Powers to defend them.

Paradoxes unbounded: Practising community making

The first section of this paper is a discussion of the paradoxes contained in the word ‘community’, which deliberately foregrounds and problematises these conflicting meanings before arguing for a third definition and practice of community that transcends and even celebrates contradictions within an active learning model of education in the community aimed at tackling inequality and prejudice. The second section offers an autocritical narrative account of an education in the community project which illustrates how such a practice of community making can be achieved within an educational framework in which pupil is teacher and teacher is pupil. The paper draws upon theoretical models from the fields of community development, inclusive and creative education, emancipatory action research, postmodernism and postcolonialism.

Recruiting Participants for Randomized Controlled Trials of Music Therapy: A Practical Illustration

Background: Failure to recruit sufficient numbers of participants to randomized controlled trials is a common and serious problem. This problem may be additionally acute in music therapy research.

Objective: To use the experience of conducting a large randomized controlled trial of music therapy for young people with emotional and behavioral difficulties to illustrate the strategies that can be used to optimize recruitment; to report on the success or otherwise of those strategies; and to draw general conclusions about the most effective approaches.

Methods: Review of the methodological literature, and a narrative account and realist analysis of the recruitment process.

Results: The strategies adopted led to the achievement of the recruitment target of 250 subjects, but only with an extension to the recruitment period. In the pre-protocol stage of the research, these strategies included the engagement of non-music therapy clinical investigators, and extensive consultation with clinical stakeholders. In the protocol development and initial recruitment stages, they involved a search of systematic reviews of factors leading to under-recruitment and of interventions to promote recruitment, and the incorporation of their insights into the research protocol and practices. In the latter stages of recruitment, various stakeholders including clinicians, senior managers and participant representatives were consulted in an attempt to uncover the reasons for the low recruitment levels that the research was experiencing.

Conclusions: The primary mechanisms to promote recruitment are education, facilitation, audit and feedback, and time allowed. The primary contextual factors affecting the effectiveness of these mechanisms are professional culture and organizational support.

Pharmacological interventions for dementia in people with Down Syndrome (Protocol).

Background: People with Down syndrome are vulnerable to developing dementia at an earlier age than the general population. Alzheimer’s disease and cognitive decline in people with Down syndrome can place a significant burden on both the person with Down syndrome and their family and carers. Various pharmacological interventions, including donepezil, galantamine, memantine and rivastigmine, appear to have some effect in treating cognitive decline in people without Down syndrome, but their effectiveness for those with Down syndrome remains unclear. Objectives: To assess the effectiveness of anti-dementia pharmacological interventions and nutritional supplements for treating cognitive decline in people with Down syndrome. Search methods In January 2015, we searched CENTRAL, ALOIS (the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group), Ovid MEDLINE, Embase, PsycINFO, seven other databases, and two trials registers. In addition, we checked the references of relevant reviews and studies and contacted study authors, other researchers and relevant drug manufacturers to identify additional studies. Selection criteria: Randomised controlled trials (RCTs) of anti-dementia pharmacological interventions or nutritional supplements for adults (aged 18 years and older) with Down syndrome, in which treatment was administered and compared with either placebo or no treatment. Data collection and analysis Two review authors independently assessed the risk of bias of included trials and extracted the relevant data. Review authors contacted study authors to obtain missing information where necessaryMain results Only nine studies (427 participants) met the inclusion criteria for this review. Four of these (192 participants) assessed the effectiveness of donepezil, two (139 participants) assessed memantine, one (21 participants) assessed simvastatin, one study (35 participants) assessed antioxidants, and one study (40 participants) assessed acetyl-L-carnitine. Five studies focused on adults aged 45 to 55 years, while the remaining four studies focused on adults aged 20 to 29 years. Seven studies were conducted in either the USA or UK, one between Norway and the UK, and one in Japan. Follow-up periods in studies ranged from four weeks to two years. The reviewers judged all included studies to be at low or unclear risk of bias. Analyses indicate that for participants who received donepezil, scores in measures of cognitive functioning (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) -0.27 to 1.13) and measures of behaviour (SMD 0.42, 95% CI -0.06 to 0.89) were similar to those who received placebo. However, participants who received donepezil were significantly more likely to experience an adverse event (odds ratio (OR) 0.32, 95% CI 0.16 to 0.62). The quality of this body of evidence was low. None of the included donepezil studies reported data for carer stress, institutional/home care, or death. For participants who received memantine, scores in measures of cognitive functioning (SMD 0.05, 95% CI -0.43 to 0.52), behaviour (SMD -0.17, 95% CI -0.46 to 0.11), and occurrence of adverse events (OR 0.45, 95% CI 0.18 to 1.17) were similar to those who received placebo. The quality of this body of evidence was low. None of the included memantine studies reported data for carer stress, institutional/home care, or death. Due to insufficient data, it was possible to provide a narrative account only of the outcomes for simvastatin, antioxidants, and acetylL-carnitine. Results from one pilot study suggest that participants who received simvastatin may have shown a slight improvement in cognitive measures. Authors’ conclusions Due to the low quality of the body of evidence in this review, it is difficult to draw conclusions about the effectiveness of any pharmacological intervention for cognitive decline in people with Down syndrome.

The uses of the outline for cultural formulation of the DSM-IV : from case conceptualization to treatment plan

ARTICLE 1 : RÉSUMÉ Amputation traumatique: Une étude de cas laotien sur l’indignation et l’injustice. La culture est un contexte essentiel à considérer pour produire un diagnostic et un plan d’intervention psychiatrique. Une perspective culturelle met en relief le contexte social dans lequel les symptômes émergent, et comment ils sont interprétés et gérés par la personne atteinte. Des études ethnoculturelles sur les maladies nous suggèrent que la plupart des gens nous donnent des explications pour leurs symptômes qui ont un fondement culturel. Bien que ces explications contredisent la théorie biomédicale, elles soulagent la souffrance des patients et leur permettent de donner une signification à cette dernière. L’exploration des caractéristiques, contextes et antécédents des symptômes permet au patient de les communiquer au clinicien qui pourrait avoir une explication différente de sa maladie. Cette étude de cas permet de montrer comment le Guide pour Formulation Culturelle du DSM-IV (The DSM-IV Outline for Cultural Formulation) permet aux cliniciens de solliciter un récit du patient en lien avec son expérience de la maladie. Notre étude examine l’utilisation par un patient laotien de « l’indignation sociale » (« Khuâm khum khang ») comme le modèle explicatif culturel de son problème malgré le diagnostic de trouble de stress post-traumatique qui lui fut attribué après une amputation traumatique. L’explication culturelle de son problème a permis au patient d’exprimer la signification personnelle et collective à sa colère et sa frustration, émotions qu’il avait réprimées. Cet idiome culturel lui a permis d’exprimer sa détresse et de réfléchir sur le système de soins de santé et, plus précisément, le contexte dans lequel les symptômes et leurs origines sont racontés et évalués. Cette représentation laotienne a aussi permis aux cliniciens de comprendre des expériences et les explications du client, autrement difficiles à situer dans un contexte biomédical et psychiatrique Euro-américain. Cette étude démontre comment il est possible d’améliorer les interactions entre cliniciens et patients et dès lors la qualité des soins par la compréhension de la perspective du patient et l’utilisation d’une approche culturelle. Mots clés: Culture, signification, idiome culturel, modèle explicatif, Guide pour Formulation culturelle du DSM-IV, indignation sociale, interaction entre patient et intervenant. ARTICLE 2 : RÉSUMÉ Impact de l’utilisation du Guide pour la formulation culturelle du DSM-IV sur la dynamique de conférences multidisciplinaires en santé mentale. La croissance du pluralisme culturel en Amérique du nord a obligé la communauté oeuvrant en santé mentale d’adopter une sensibilité culturelle accrue dans l’exercice de leur métier. Les professionnels en santé mentale doivent prendre conscience du contexte historique et social non seulement de leur clientèle mais également de leur propre profession. Les renseignements exigés pour les soins professionnels proviennent d’ évaluations cliniques. Il faut examiner ces informations dans un cadre culturellement sensible pour pouvoir formuler une évaluation des cas qui permet aux cliniciens de poser un diagnostic juste et précis, et ce, à travers les frontières culturelles du patient aussi bien que celles du professionnel en santé mentale. Cette situation a suscité le développement du Guide pour la formulation culturelle dans la 4ième édition du Manuel diagnostique et statistique des troubles mentaux américain (Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) de l’Association psychiatrique américaine. Ce guide est un outil pour aider les cliniciens à obtenir des informations de nature culturelle auprès du client et de sa famille afin de guider la production des soins en santé mentale. L’étude vise l’analyse conversationnelle de la conférence multidisciplinaire comme contexte d’utilisation du Guide pour la formulation culturelle qui sert de cadre dans lequel les pratiques discursives des professionnels de la santé mentale évoluent. Utilisant la perspective théorique de l’interactionnisme symbolique, l’étude examine comment les diverses disciplines de la santé mentale interprètent et conceptualisent les éléments culturels et les implications de ce cadre pour la collaboration interdisciplinaire dans l’évaluation, l’élaboration de plans de traitement et des soins. Mots clé: Guide pour Formulation culturelle – Santé mentale – Psychiatrie transculturelle – Analyse conversationnelle – Interactionnisme symbolique

Police officers' and legal professionals' perceptions regarding how children are, and should be, questioned about repeated abuse

This study explored the perceptions of police officers and legal professionals (i.e., prosecutors, defence lawyers and a judge) about (a) what particularisation is, (b) the type of information that is required for particularisation to occur, and (c) how particularisation is best achieved in cases of repeated child abuse. The professionals' perceptions (all experts in this area) were elicited via individual in-depth semi-structured interviews. While all participants acknowledged the importance of particularisation, the views of the police officers varied in several important ways to those of the other professionals. Overall, the police officers perceived that highly specific details (such as the location, date and time of the offence) are essential for particularisation to occur, and that maximising the number of separate offences and specific details about each offence increases the chance of successful prosecution. In contrast, the legal professionals perceived that the primacy goal of the police officers should be to elicit a free-narrative account of one or more offences. A high proportion of specific questions was perceived to negatively impact on the child's credibility by contaminating the evidence. The implications of these findings are discussed.

The effect of intellectual disability on the adherence of child witnesses to a “story grammar” framework

BackgroundThis study examined the ability of 78 children (aged 9–12 years) with an intellectual disability (ID) to provide a narrative account of a staged event they had participated in four days earlier.
MethodThe children were interviewed using open‐ended questions. The quality of their responses (using a story grammar framework) was compared with that of two control groups: mainstream children matched for mental and chronological age.
ResultsWhile the children with an ID and those matched for mental age provided narratives of similar length and used similar proportions of each story grammar element, the ID group was less likely than both control groups to provide a narrative account at all. Among those children with an ID who did provide a narrative account, their accounts included proportionately fewer story grammar elements than those of both control groups.
ConclusionChildren with an ID are disadvantaged as witnesses with respect to their ability to provide a detailed and coherent narrative account of events under optimal investigative interviewing conditions.

Evaluation of the questions used to elicit evidence about abuse from child witnesses : Australian study

This study provides one of the first objective evaluations of the performance of a group of Australian police officers when conducting interviews about child abuse. The interviews included 136 videotaped child witness statements, conducted between 2001 and 2007 by police officers from two jurisdictions of Australia. The results indicated many positive aspects of the interviewers' performance, including the use of ground rules at the outset of the interview, commencement of the free-narrative account by seeking the children's understanding of the purpose of the interview, and avoidance of suggestive questions. But the interviewers tended to raise issues of contention when the child did not provide an initial disclosure, and the proportion of open-ended questions was low relative to specific cued-recall and closed questions. Further many closed questions raised specific details not yet mentioned by the child. These behaviours were exhibited irrespective of the recency of interview or time since training. The implications of these findings are discussed.

Improving child investigative interviewer performance through computer-based learning activities

The current study adopted a pre- versus post-training design and a standardised measure of performance to evaluate the effectiveness of a series of online computerbased learning activities designed to encourage open-ended question usage among investigative interviewers of children. Participants included 61 social workers, police and psychologists. The learning activities, organised into 12 modules of approximately 3 hours duration each, focused purely on the skill of eliciting a disclosure of sexual abuse and a narrative account of the offence from a young child. Results revealed a significant improvement in interview performance from pre-training to immediate post-training. For the 25 participants who also completed a follow-up assessment three to six months after completing the learning activities, performance was found to be maintained. The implications of these findings and directions for future research are discussed.