Le soutien entre patients hospitalisés en milieu psychiatrique : une ressource infirmiere peu reconnue Marjorie Montreuil, Institut universitaire Douglas.

Présentation au sujet: "Le soutien entre patients hospitalisés en milieu psychiatrique : une ressource infirmiere peu reconnue Marjorie Montreuil, Institut universitaire Douglas."— Transcription de la présentation:

1 Le soutien entre patients hospitalisés en milieu psychiatrique : une ressource infirmiere peu reconnue Marjorie Montreuil, Institut universitaire Douglas en santé mentale & Lindsay Bouchard Étudiantes M.Sc.(A), École de sciences infirmières, Université McGill Catherine Gros Infirmière clinicienne spécialisée, Institut universitaire Douglas en santé mentale Assistante Professeur, Université McGill We will present to you our project entitled: Peer support among inpatients in an adult mental health setting. This project was done with Lindsay Bouchard, and I’m Marjorie Montreuil. Our advisor is Catherine Gros, a nurse clinician specialist at the Douglas and faculty lecturer at McGill. The project received funding from the Ministère de l’éducation, du loisir et su sport du Québec, in association with McGill university. In addition, we received funding from the Douglas Institute. Funding: Bourse du Ministère de l’éducation, du loisir, et du sport du Québec et de l’Université McGill Bourse de la Direction des soins infirmiers, Institut Douglas Bourse de recherche de la fondation des sciences infirmières, Institut Douglas

2 Plan de la présentation: Le soutien entre patients hospitalisés en milieu psychiatrique
Contexte et discussion: Observations, experiences, points de vu Question de recherche, définitions de termes Méthodologie Description de l’échantillon Résultats Reflexions et Discussion Implications pour la pratique infirmière Questions, defis et future directions

3 Contexte du soutien par les pairs
Important pour les personnes atteint d’une maladie mentale La recherche antérieure est axée sur les personnes dans la communauté Pourtant… Le milieu hospitalier psychiatrique est un environment unique qui favorise l’interaction entre les pairs. Espace de vie commun partagé 24/7 Existing literature indicates that peer support is beneficial for people with mental illnesses and it plays an important role in recovery. However, previous research on peer support in the mental health field has focused on formalized peer support interventions within community health services. Very little research has been done in the inpatient setting. In Canada, the current average length of stay in psychiatric institutes is about 100 days, with a median of 26 days. Given this lengthy hospitalization period inpatients have the time and opportunity to interact with each other. Patients are sharing the same living space 24 hours a day, 7 days a week. In this context, we came up with the following question: “What are the perceptions and experiences of peer support among adults on an inpatient unit of a mental health institute during the period of their hospitalization?”

4 Question de recherche Quelles sont les perceptions et expériences du soutien par les pairs entre adultes hospitalisés sur des unité de soins en milieu psychiatrique ?

5 Question: Quelles sont vos perceptions, expériences points de vu et observations envers le soutien par les pairs en milieu psychiatrique Discussion & Reflexion

6 Définition du soutien par les pairs
Interaction volontaire et spontanée qui a lieu naturellement Implique donner et recevoir du support Adresse des problématiques individuelles ou des préoccupations partagées Peut être composée d’assistance émotionnelle, évaluative ou informationnelle For the purposes of this study, the definition of peer support is based on the conception of mutual and peer support from different authors. A relationship in which persons voluntarily and spontaneously interact to give and receive help, addressing individual issues or shared concerns. This support could be composed of “emotional, appraisal, and informational assistance…to address a health-related issue” (Dennis, 2003, p. 329). (Davidson et al., 1999; Mead, Hilton, & Curtis, 2001; Dennis, 2003)

7 Méthodologie Approche qualitative (descriptive)
Entrevues individuelles semi-structurées Données collectées à l’automne 2009 Employés impliqués dans le recrutement des patients sur 4 unités: Burgess1, CPC2, Perry 2A, CPC3 Critères d’inclusion des participants Adultes hospitalisés parlant français ou anglais Cognitivement aptes à discuter de leurs perceptions et expériences We used a qualitative descriptive design and data was collected through face-to-face semi-structured interviews. The interviews were conducted in September and October 2009 on 4 inpatient units of a mental health institute, 2 long term and 2 short term. The inclusion criteria for the study were: inpatients, 18 years and older, hospitalized on one of four selected units, English or French speaking, cognitively able to discuss their experiences and perceptions. An effort was made to have a diverse sample by purposefully choosing people with different gender, ages, and lengths of stay..

8 Description de l’échantillon
10 participants Âge: 26 à 64 ans Moyenne de durée d’hospitalisation: 72 jours Diagnostiques des participants: Dépression (2) Schizophrénie (6) Trouble psychotique non identifié (2) Ten participants participated in the study. Four were women and six were men. The participants were evenly split between long-term units and short-term units. All had previous experiences as inpatients in mental health institutions with the exception of one participant. The participants’ ages ranged from years old, average 47 years old. Their length of stay on the unit ranged from 10 days to over a year and a half. Median 72 days. For the diagnosis, two participants were diagnosed with depression, six with schizophrenia (one also had borderline personality traits and another had antisocial personality), and two with nonspecific psychotic disorders.

9 Caractéristiques personnelles
Résultats Penser aux pairs Aider les pairs par des actions Nature du soutien entre pairs Contexte Caractéristiques personnelles Dynamiques de groupe Facteurs structurels Résultats de donner et recevoir

10 Caractéristiques personnelles
Résultats Résultats de donner et recevoir Penser aux pairs Aider les pairs par des actions Nature du soutien entre pairs Contexte Caractéristiques personnelles Dynamiques de groupe Facteurs structurels

11 Nature du soutien entre pairs (1)
Penser aux pairs “I believe in helping and witnessing, seeing what you see, in another patient … we notice, you know, pay attention to what’s going on.” “Je le vois qu’ils sont tous seuls, qu’ils auraient juste besoin de parler.” Thinking about peers: -The participants perceived that in order to give peer support, they needed to observe their peers on the unit and think about others’ experiences. -QUOTE 1: One patient said: “I believe in helping and witnessing, seeing what you see, in another patient … we notice, you know, pay attention to what’s going on.” -Observing and reflecting on their peers’ experiences allowed them to be aware of challenges that their peers were facing and to recognize peer needs. -QUOTE 2: Also when talking about other patients on the unit, one patient reported: “I can see that they are all alone, they would just need to talk [to someone].” This shows that the person is thinking about what another patient needs. As presented in the diagram before, this kind of appraisal can lead to specific helping strategies. From the participant interviews, five types of helping actions were identified. They ranged from simple, concrete acts of: sharing material goods, helping with activities of daily living, and sharing a social life to more involved interventions of: sharing advice and information and providing emotional support and encouragement. 11

12 Nature du soutien entre pairs (2)
Aider les pairs par des actions Partager des biens matériels “I gave to people. I gave lunches, I gave cigarettes … it can be anything, a piece of clothing, a word, anything, you know.”  2. Aider dans les activités quotidiennes “J’essaye de lui dire de se lever. Parce qu’il y a beaucoup de patients … qui ne se lèvent pas pour manger, ils restent dans leurs lits. Donc on essaye de stimuler les gens.” “Quand il [un patient à mobilité réduite] est assis dans sa chaise et qu’il veut se lever, je mets ma main en dessous de son bras, et je l’aide à se lever.” Nature of peer support: -First, all ten participants perceived that peer support included giving and receiving tangible things on the unit, for example food, books, cigarettes, money, and clothing. -QUOTE 1: As one participant said, “I gave to people. I gave lunches, I gave cigarettes … it can be anything, a piece of clothing, a word, anything, you know.”  -Second, participants reported helping with activities of daily living, for example: These activities included helping with personal hygiene and laundry, running errands, announcing phone calls for other patients, sharing visits with friends and family, and assisting peers to stay on schedule. -QUOTE 2: This was shown by one participant when he said, “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.” -Participants also shared stories about helping peers who had limited mobility or physical problems: -QUOTE 3: “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.” 12

13 Nature du soutien entre pairs (3)
Aider les pairs par des actions 3. Partager une vie sociale “We enjoy getting food and eating that together … We talk a lot, we all joke.” 4. Offrir du soutien émotionnel et de l’encouragement “je parle à un autre patient de mes problèmes, des choix que j’ai faits dans le passé que je regrette, et de mon impression d’avenir bouché … Il essaie toujours de me faire voir le côté positif de la vie.” -Third, peer support included the development of a peer network in which patients did things together, such as watching television, chatting, playing games, and laughing. -QUOTE1: One participant stated, “We enjoy getting food and eating that together … We talk a lot, we all joke.” -Fourth, participants perceived that peer support also included an emotional component. Some patients shared feelings and worries, provided stress relief and comfort, offered friendship, expressed positive thoughts for peers, encouraged each other, and reframed their hospitalization experience. -QUOTE 2: To illustrate these emotional support, one participant said, “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.”

14 Nature du soutien entre pairs (4)
Aider les pairs par des actions 5. Partager des conseils et de l’information « Alors il m’a donné des idées, des pistes de réflexion. Un peu comme les infirmières font, mais les patients le font aussi entre eux. » “I saw [another patient], she doesn’t talk much. I go, ‘why don’t you get a radio and listen to the radio, listen to some music. It will distract you.’ She did it, bought a radio, and she’s a little better.” -Lastly, participants also reported sharing advice and information, which was related to a peer’s behavior and based on the helper’s past experiences. The information peers shared was about their current hospitalization, their medical treatment, and the structure and functioning of the institute or to past experiences. -For example, one participant explained that she was able to give advice to a peer who had a problem with gambling because she had struggled with the same issue in the past. -A few participants explained that peers could offer information and advice in collaboration with health care professionals by referring peers to staff when needed, reinforcing their advice, and complementing their interventions. -QUOTE 1: To illustrate this, one patient said, “So he [another patient] gave me some ideas, some paths of reflections. A little like the nurses do, but the patients do it also between each other.” -The same participant explained that patients were more likely to follow staff’s advice if other patients reiterated the advice to them. -Participants were also able to give examples of when other patients had offered helping advice that produced a beneficial effect. -QUOTE 2: One participant told a story about helping a peer who was hearing voices by offering advice that was based on his previous experience: “I saw [another patient], she doesn’t talk much. I go, ‘why don’t you get a radio and listen to the radio, listen to some music. It will distract you.’ She did it, bought a radio, and she’s a little better.” -As you can see form this quote, the helping action led to a positive outcome for a fellow patient.

15 Caractéristiques personnelles
Résultats Résultats de donner et recevoir Penser aux pairs Aider les pairs par des actions Nature du soutien entre pairs Outcomes: -When peer support occurred, all of the outcomes that the participants reported were positive. -These outcomes, which were linked to specific helping actions, had a wide variety of benefits. Participants identified outcomes of both receiving and giving peer support. One outcome for recipients and providers of peer support that was stated by all participants was feeling “good” and “happy.” Contexte Caractéristiques personnelles Dynamiques de groupe Facteurs structurels

16 Résultats du soutien par les pairs (1)
Résultats de recevoir du soutien Meilleur état émotionnel Meilleure perspective de la situation Changements positifs dans le comportement “Il y en a une ça n’a pas rapport quand elle parle … elle n’a pas le temps de finir sa phrase et elle parle d’une autre affaire tout de suite, et une autre petite phrase, et une autre petite phrase … Je lui dis: ‘C’est quoi que tu voulais finir de converser, et ce que tu veux expliquer?’ Et j’essaye de savoir ce qu’elle veut dire, ce qu’elle essaye de comprendre ou de me faire comprendre, ou de faire comprendre aux autres … [Maintenant] elle parle un peu plus, elle commence à ajouter un peu plus de mots à ses phrases.” -Support from peers improved the recipients’ outlook on their current situation, behavior, and emotional state, e.g. feeling less alone, anxious, or stressed. -One participant explained that another patient gave her “insight” and “self-awareness,” and helped her “understand the situation … [while feeling] more in control.” -The positive behavioral changes that resulted from peer support included an increased participation in group activities, adoption of healthier behaviors, and improved communication with staff and peers. -QUOTE 1: One participant showed this by sharing the story of another patient who was always repeating herself and had a hard time communicating with other patients and staff: “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 understand or 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.” -From this story, you can see that the participant was thinking about a peer’s situation and how he could help her. It resulted in an increased ability for the peer to expressed herself.

17 Résultats du soutien par les pairs (2)
Résultats de donner du soutien “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.” “Je peux être une bonne oreille pour lui [un autre patient]. Je pense que c’est un beau cadeau, un bonus dans ma journée.” “[We would] reminisce, talk about different things … You know, you felt happy, you know what I mean? … The friendships I made here helped a lot.” -Providing peer support commonly resulted in receiving gratitude from peers in the form of verbal thanks. -Other outcomes that some participants reported included feeling “more safe” and “fulfilled,” and gaining “some spirit, motivation,” and “comfort.” -QUOTE 1: One participant explained about helping others, “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.” -QUOTE 2: Another participant described how he enjoyed being there to listen to peers; he said , “I can be a good ear for him [another patient], I think that it’s a beautiful gift, a good bonus in my day.” -Offering peer support could also result in the formation of friendship. -QUOTE 3: One participant explained that she often supported other patients on the unit, some of which became her friends. When talking about what she and her roommate did together, she said “[we would] reminisce, talk about different things … You know, you felt happy, you know what I mean? … The friendships I made here helped a lot.” -So, the study participants articulated beneficial outcomes for both the person receiving and giving peer support on the units.

18 Caractéristiques personnelles
Résultats Résultats de donner et recevoir Penser aux pairs Aider les pairs par des actions Nature du soutien entre pairs Context of peer support: -Participants identified facilitators and barriers of peer support, which could be grouped into three categories: personal characteristics of peers, group dynamics on the unit, and structural factors of the institute. -Based on the data from the participants, the context of being hospitalized on a short or long term stay unit did not result in remarkable differences in peer support perceptions and experiences. Contexte Caractéristiques personnelles Dynamiques de groupe Facteurs structurels

19 Contexte du soutien par les pairs (1)
Caractéristiques personnelles Traits, compétences, et valeurs qui peuvent encourager le soutien par les pairs “[Another patient] understood what I was going through, because she went through it herself.” Donner/recevoir malgré un trouble de santé mentale “It always makes me feel good to look after somebody. Even if I’m sick myself, and I do it.” “même s’ils [les autres patients] ont des problèmes, il faut les aider, je pense.” -In relation to personal characteristics, participants identified various traits, skills, and beliefs that encouraged peer support. For example, supportive interactions were facilitated when patients were smiling, using humor, and communicating in a collaborative manner. -Participants also described patients who provided peer support as “knowledgeable,” “kind,” “sincere,” “friendly,” “empathetic,” and “available.” -In addition, they often had common personal experiences with their peers. -QUOTE 1: One participant stated, when speaking about another patient, “she understood what I was going through, because she went through it herself.” -A common thread that emerged from the interviews was the idea of giving and receiving peer support despite having a mental illness. Several participants explained that they helped peers even though they were “sick” themselves. -QUOTE 2: One patient said, “It always makes me feel good to look after somebody. Even if I’m sick myself, and I do it.” -With some peers it was more difficult to establish a helping relationship because of their behaviors “that are annoying” or their withdrawn attitudes; despite this challenge, participants were still able to provide peer support. This was shown in the previous example about the radio, in which a patient gave a peer advice even though she “didn’t talk much” because of her symptoms. 19

20 Contexte du soutien par les pairs (2)
Dynamique de groupe “One good turn deserves another.” “I just mind my own business. They [the other patients] haven’t encouraged me to be friends with them…[I wish that other patients would] be more outgoing and make an effort to communicate.” “Il y a des petites gangs. Mais il y a un bon esprit d’équipe pareil … Il y a des amitiés qui se créent ici.” Facteurs structurels « L’infirmière m’a dit: “Après ça il va plus t’aider lui. Aide le pas, il va pas t’aider.” » -Regarding group dynamics, participants reported that the unit environment could be a facilitator or barrier to peer support. -Most of the participants perceived that they were “getting along well” with a good number of the other patients and had friends on the units. -Participants reported that there was “lots of respect” and reciprocity among patients.For example: QUOTE 1: “One good turn deserves another.” -Other people felt that they didn’t belong on the unit, making it harder to interact with other patients. -QUOTE 2: One patient reported: “I just mind my own business. They [the other patients] haven’t encouraged me to be friends with them…[I wish that other patients would] be more outgoing and make an effort to communicate.” -But despite these barriers, all participants still reported that were receiving or giving peer support. -For structural factors, about half of the participants identified barriers of peer support related to health professional practices. --Participants explained that health care professionals sometimes discouraged practices that participants perceived as peer support, such as sharing cigarettes or soft drinks. -QUOTE 3: One participant explained that a nurse had told him: “Don’t help him [another patient], he’s not going to help you.’ ”

21 Discussion (1) Les pairs sont une source importante de support varié et unique Éventail plus large d’actions de soutien qu’anticipé Occurrence spontanée du soutien malgré un diagnostic en santé mentale Le soutien entre patients a lieu en tandem avec les soins professionnels Offrir des conseils basés sur l’expérience résulte en un sentiment de compétence et un lien social particulier pour les patients The findings of the present study bring forth novel perspectives and insight regarding naturally occurring peer support among inpatients in an adult mental health setting. It is in fact the first study exploring the experiences of peer support among mental health inpatients. The results first suggest that peers are an important source of diverse and unique support. The helping actions identified by the participants were broader in scope than what was originally expected. The study’s initial definition of peer support that focused on “emotional, appraisal, and informational assistance”. While these three components were represented in the descriptions of peer support reported by study participants, but they also mentioned the occurrence of tangible support (i.e. sharing material goods and helping with activities of daily living) and also the presence of positive social interactions, which was exemplified by the “sharing a social life”. These additional components are types of support that can be seen in the broader social support literature, but that are not usually coming solely from peers.

22 Discussion (2) Le soutien entre pairs peut conduire à l’amélioration des symptômes liés aux problèmes de santé mentale Le soutien entre pairs améliorent les 5 dimensions de la qualité de vie: 1. l’état physique 2. les fonctions psychologiques 3. le niveau d’indépendance 4. l’environnement 5. les relations sociales The last point of the discussion is about how peer support can contribute to improve the patients’ mental health outcomes and their quality of life. The outcomes of receiving peer support were described in the results as effecting positive changes in patients’ emotions, behaviors, and perspectives. These outcomes have the potential to be significant, especially in this population, because mental illnesses are identified by changes in thinking, behavior, or mood. This suggests that naturally occurring peer support can contribute to improving patients’ mental health states. In fact, literature suggests that not acknowledging the importance of supportive relationships for people with a mental illness may impede optimal patient outcomes. Experiencing social support is linked with having an improved quality of life. According to the World Health Organization (2000), quality of life is composed of five dimensions: physical states and functions, psychological functions, levels of independence, environment, and social relationships. The first dimension, improved physical functioning, was reflected in participants’ reports that peer support resulted in adopting healthier behaviors, such as walking outside. Their psychological functioning, the second dimension, was improved by experiencing an increased happiness, cognitive functioning, feeling of hope, and decreased anxiety after receiving peer support. The next dimensions, levels of independence and environment, were improved by an increased participation in activities, ability to carry out activities of daily living, communication capacity, acquisition of knowledge, and feelings of safety. Social relationships, the last dimension, were improved as peer support increased social contact, supportive activities, and feelings of being supported.

23 Questions à discuter Quelle est votre opinion par rapport à cette recherche? Quels résultats concordent avec vos observations cliniques et votre expérience ? Quels résultats vous surprennent ? Comment croyez-vous que le soutien par les pairs pourrait être intégré dans votre pratique clinique ? Quelles questions est-ce que cette recherche soulève pour vous ?

24 Implications pratiques (1)
Offrir une vision plus complète de l’expérience des patients par rapport au soutien entre pairs Remettre en question certaines croyances non fondées sur le soutien entre patients Contribuer à améliorer la reconnaissance du soutien entre pairs et permettre aux professionnels de la santé de supporter les forces et compétences des patients The findings of the present study are directly relevant to mental health practice by offering health care professionals a more comprehensive view of patients’ perceived experiences of peer support. In the current study, participants reported a lack of recognition or acknowledgement from staff and even sometimes discouragement of supporting their peers. This might reflect a constraining belief that peer support does not occur among mental health inpatients or that it is not appropriate. The findings from this study offer insight into the unique role hospitalized mental health patients play in one another’s recovery. This understanding can be used by health professionals to recognize peer support in order to facilitate, encourage, and promote beneficial peer interactions. Awareness of the potential for and occurrence of naturally occurring peer support among hospitalized patients provides an avenue for health professionals to support patients’ resources and capabilities.

25 Implications pratiques (2)
Interventions pour promouvoir le soutien entre pairs Explorer, identifier, et reconnaître les moyens par lesquels les patients offrent et reçoivent du soutien entre pairs Offrir du support Identifier les résultats Célébrer les succès Some interventions aimed at creating a supportive environment could then be used to promote peer support, an ability and strength of patients. Consistent with the McGill Model of Nursing, recommended strategies include: exploring, identifying, and acknowledging the ways in which individual patients offer and receive peer support, providing positive feedback, being a supportive presence, identifying outcomes, and celebrating successes. In sum, health professionals are in an ideal position to work in partnership with hospitalized patients by identifying and cultivating supportive peer relationships, thereby further enabling patients to benefit from the various positive outcomes that peer support can provide.

26 Limitations Échantillon limité Possibilité de biais
-In the present study, an effort was made to have a diverse sample by purposefully including people with different characteristics; however, the sample size was small and data saturation would enhance the validity of the findings. -In addition, participants were selected based on health care professionals’ clinical judgment of the patients’ ability to be part of the study and on the patients’ willingness to participate. The selection of participants may have been biased through the staff recruitment suggestions and patients’ voluntary participation toward patients who had more positive peer interactions on the units. -Therefore, the perceptions and experiences of the study participants may not represent those of the general population of adult mental health inpatients.

27 Directions pour la recherche au future
Faire des études avec des échantillons plus nombreux pour explorer les différences entre les différents diagnostics et les types d’unité Explorer davantage: la relation entre le soutien entre pairs et la gestion des symptômes la perception et l’expérience du personnel par rapport au soutien entre patients -In conclusion, this study indicates that peer support does occur spontaneously on adult mental health inpatient units in a diversity of ways. Additionally, peer support is beneficial for both the providers and recipients. Therefore, this suggests that nurses should recognize and encourage peer support interactions among patients. -Further research on peer support among inpatients needs to be conducted with larger samples in different locations to validate the current findings. Moreover, differences between various diagnoses and types of units could be explored further, as well as the specific effects of peer support on symptom management. -This study did not address staff’s perceptions and experiences of peer support among patients, which could also be explored in future studies to gain a more complete understanding of the phenomenon of peer support on inpatient units.

28 Remerciements Dr. Margaret Purden, McGill University
Mme Helene Racine, DSI, Institue Douglas Chefs clinico-administratifs du Douglas: Benoît Maréchal, Dominique Paquin, Amine Saadi, et Ina Winkelmann Les infirmières sur les unités et le personnel administratif Le MELS, l’université McGill, et l’institut Douglas Bien sûr, les participants au projet!

29 Références Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. K. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6, Dennis, C. L. (2003). Peer support within a health care context: A concept analysis. International Journal of Nursing Studies, 40, 321–332. Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25,