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Improving Patient ECG Experience Within Perinatal Mental Health and Enabling Better Antipsychotic Physical Health Monitoring
- Cameron Kendall, Emma Livesey, Sally Arnold
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S98
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- Article
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Aims
An ECG should be undertaken as part of physical health monitoring for newly admitted patients and as part of antipsychotic initiation and monitoring. This project compared patient experience between a traditional 12 lead ECG and a 6 lead hand held ECG device (KardiaMobile 6L device). The intention was to make ECGs within perinatal mental health better tolerated, subsequently improving physical health monitoring. On our mother and baby unit, patients were reluctant to expose the chest area to have a 12 lead ECG performed due to factors including breastfeeding and feeling self-conscious about postnatal body changes. Inability to perform 12 lead ECGs, due to lack of patient consent, increased the chance of antipsychotic prescribing without baseline monitoring. We sought to find an alternative, more acceptable way to monitor physical health in this cohort, so we could improve the safety of prescribing medications and patient care as a whole.
MethodsData were gathered prospectively over a three-month period, on our eight-bed perinatal inpatient unit. Each patient had a 12 lead ECG performed on admission and then a hand held 6 lead ECG performed for monitoring purposes. Patients with pre-existing cardiac comorbidities were excluded. All ECGs were interpreted by a trained clinician, and patients provided formal feedback on their experience of having a traditional 12 lead ECG and a handheld ECG undertaken.
Results14 patients were included. All preferred the hand held ECG compared to the traditional 12 lead. Patients felt the 12 lead ECG was intrusive, describing feelings of anxiety and being uncomfortable, particularly with the amount of wires and stickers required. With the hand held device patients felt more relaxed, found the procedure easier to have done, and that it was quicker to be undertaken. All agreed they would be more likely to have regular ECGs performed if it was with the hand held device.
ConclusionAlthough a 12 lead ECG is gold standard, in patients who decline a traditional ECG, this handheld ECG would be a safer alternative rather than no ECG being undertaken.
Patient feedback is overwhelmingly positive towards the use of the handheld ECG device, particularly as less body exposure is needed. In addition the shorter time to undertake an ECG is advantageous within the perinatal setting, as mothers are also busy caring for their infants.
The greater acceptability in this cohort should lead to better physical health monitoring, both improving patient experience and prescribing safety.
Coping Following Traumatic Brain Injury:The Need for Contextually Sensitive Assessment
- Elizabeth Kendall, David Shum, Brenda Lack, Susan Bull, Cameron Fee
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- Journal:
- Brain Impairment / Volume 2 / Issue 2 / 01 December 2001
- Published online by Cambridge University Press:
- 21 February 2012, pp. 81-96
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Psychosocial adjustment problems following traumatic brain injury (TBI) frequently present a major barrier for rehabilitation. The ability to cope has been linked with psychological well-being following stressful and traumatic events, but has been poorly examined in the area of TBI. In terms of conceptualisation, most coping research has adopted the Lazarus and Folkman (1984) dichotomy of coping, namely problem-focused and emotion-focused. Despite the popularity of this theory, recent conceptualisations of coping have suggested that other dimensions are equally important and require investigation in the TBI area. However, measurement of coping continues to provide a major barrier for research in this area, particularly given the potential difficulties associated with self-report data in people with TBI. The current study used a contextually sensitive assessment technique to test current conceptualisations of coping in the TBI population. Specifically, the study examined coping strategies and styles in response to four stressful video-based scenarios. Rather than using a self-report questionnaire to assess predetermined coping strategies, participants spontaneously provided their own coping strategies, which were then coded into distinct coping strategies. The strategies were categorised into four groups according to their focus (emotion or problem) and approach (active or passive). Both the number and type of coping strategies differed across situations, providing support for the use of a contextually sensitive measurement technique. Further, the theoretically expected pattern of relationships was found between coping types and outcomes. However, these relationships differed across situations and over time, confirming suggestions that coping efficacy may differ depending on the demands of the situation and that chronic situations such as TBI may have an impact on coping style over time.
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