Showing papers in "Issues in Mental Health Nursing in 1990"
TL;DR: Whether therapy process and outcome are influenced by a client-therapist ethnicity, language, or gender match is examined and the ethical and political context of the research and the implications for mental health nursing are explored.
Abstract: The purpose of this article is to examine whether therapy process and outcome are influenced by a client-therapist ethnicity, language, or gender match. A review of research in this area does not d...
74 citations
TL;DR: To understand the meaning that being stigmatized has for persons with Acquired Immune Deficiency Syndrome (AIDS), Phenomenology provided both the theoretical framework and the method.
Abstract: The purpose of this study was to understand the meaning that being stigmatized has for persons with Acquired Immune Deficiency Syndrome (AIDS). The research question for this investigation was, What is the perception of stigmatization as experienced by persons with AIDS? Phenomenology provided both the theoretical framework and the method for this study. The sample consisted of 10 homosexual men contacted through a New Orleans hospice, home health nurses, the investigator's own personal contacts, and referrals from men who were in the project. Participants were asked open-ended questions pertaining to changes in their relationships with others since diagnosis, changes in self-esteem, and examples of prejudice and discrimination. Interviews were audiotaped, transcribed verbatim, and analyzed using a qualitative approach. The phenomenon of stigmatization emerged as experiences of rejection and protection in social interactions.
57 citations
TL;DR: The major approaches to measurement of empathy are reviewed and classifies these approaches according to the dimensions of empathy that they measure and a conceptualization of empathy is presented that considers empathy to be a multidimensional phenomenon, with emotional, cognitive, communicative, and relational components.
Abstract: Empathy is a topic of growing concern in a variety of disciplines. Although considerable empathy research is reported, often single dimensions of a multidimensional and multiphasic construct are ac...
50 citations
TL;DR: Of the independent variables of situational humor, coping humor, residence, gender, age, living arrangements, and socioeconomic status, none are significant predictors of perceived health at the .017 alpha level, whereas the variable of living arrangements is predictive of life satisfaction.
Abstract: The purpose of this investigation was to examine the relationship between the use of humor as a coping strategy and health indicators as measured by perceived health, life satisfaction, and morale in older adults. A packet of questionnaires was administered to a nonrandom sample of 73 noninstitutionalized adults over age 55. Of the independent variables of situational humor, coping humor, residence, gender, age, living arrangements, and socioeconomic status (SES), none are significant predictors of perceived health at the .017 alpha level, whereas the variable of living arrangements is predictive of life satisfaction. Furthermore, coping humor and socioeconomic status are predictive of morale in older adults. This study adds to the knowledge of humor as a coping strategy as well as a developmental concept in older adults. Implications for nursing practice and research are discussed.
45 citations
TL;DR: In this paper, the authors used a predictive validity approach to determine the degree to which findings from simulation research are transferable to the real world, using the same measure on artificial and real situations.
Abstract: Simulation methodology, as exemplified by use of vignettes, has many advantages, such as standardization of data collection procedure, control of extraneous variables, and manipulation of variables of interest. The main shortcoming is its artificiality and therefore its limited external validity. To determine the degree to which findings from simulation research are transferable to the real world, a comparison can be made using the same measure on artificial and real situations, or the researcher can determine the degree to which a score on the simulation compares with a score in the field. The predictive validity approach was used in a study that used an artificial method to study patient assault. In this study, the intent was to determine the degree of accuracy that the subjects' causal attribution scores on an assault vignette were predictive of causal attribution scores in the actual assault situation.
39 citations
TL;DR: This study examined the relationships between stress and social support systems in dealing with burnout among medical and surgical ward nurses to demonstrate main effects for amount of and satisfaction with social support and found nurses with high sources of social support reported less burnout.
Abstract: This study examined the relationships between stress and social support systems in dealing with burnout among medical and surgical ward nurses. Multiple regression analyses demonstrated main effects for amount of and satisfaction with social support, with burnout as the criterion. That is, nurses with high sources of social support and high levels of satisfaction with that support reported less burnout than nurses with few supports and less satisfaction with those supports, regardless of level of work stress. No buffering effects were found for family support. That is, nurses with high work stress and high family support did not experience lower burnout than nurses with high work stress and low family support. Implications of the results are discussed.
29 citations
TL;DR: The paper discusses the need for knowledge about the phenomenon and life review versus reminiscence, and the uses of remIniscence therapy in one-to-one interaction, in the group modality, and as a research tool are all important applications of the concept.
Abstract: The nursing literature states that reminiscence is an independent nursing intervention for elderly clients and patients. This paper is about the use of reminiscence by nurses in all settings. Nurses have not to date built a firm knowledge base. The paper discusses the need for knowledge about the phenomenon and life review versus reminiscence. The uses of reminiscence therapy in one-to-one interaction, in the group modality, and as a research tool are all important applications of the concept. In contrast to other disciplines, reminiscence therapy, as studied by nurses, focuses on interventions. Reminiscence is a fascinating, elusive, and complex phenomenon, but although nursing textbooks tout its usefulness, the research findings are less optimistic.
25 citations
TL;DR: The nursing theory, Modeling and Role-Modeling, is presented as an example of a theoretical perspective that encompasses the holistic orientation and case examples of how this theory has been used in clinical practice are offered.
Abstract: This article examines the differences between wholistic nursing and holistic nursing and proposes that the latter conceptualization is more effective for contemporary nursing care. First, a brief historical overview and critique of the two concepts is given. The nursing theory, Modeling and Role-Modeling, is presented as an example of a theoretical perspective that encompasses the holistic orientation. Case examples of how this theory has been used in clinical practice are offered.
23 citations
TL;DR: To the extent that psychiatric/mental-health nursing practice is based on inadequate theories or dated or flawed research, or both, the authors' clients are not well served.
Abstract: This article reviews theoretical and empirical perspectives on anger as well as conceptualizations of anger through history. Although anger was once considered a sin or a madness to be avoided, Darwinian evolutionary theory and Freudian theory gave rise to a ventilationist approach that views expression of anger as an unequivocal good. However, global facilitation of anger can be harmful, and its benefits are not supported by research evidence. Other myths and assumptions about anger are challenged in this literature review. To the extent that psychiatric/mental-health nursing practice is based on inadequate theories or dated or flawed research, or both, our clients are not well served.
17 citations
TL;DR: A conceptual linkage between exchange theory and psychoanalytic theory of depression demonstrates that it is through the pathway of depressive moods that ill health, retirement, and stress have their negative effects on the marital relationship.
Abstract: This study demonstrates a conceptual linkage between exchange theory and psychoanalytic theory of depression. The effects of diminished resources and the dynamic relationships between depression, quality of the marital relationship, and social participation were investigated with a sample of 229 community residing, married older people (Duke Longitudinal Study) using a combined structural and measurement model with linear structural relations (LISREL) analysis. Findings are that some resources have direct effects on depression, marital quality, and social participation. However, it is through the pathway of depressive moods that ill health, retirement, and stress have their negative effects on the marital relationship. Depressive moods do affect social participation, but psychosomatic symptoms of depression do not affect the amount of social participation nor the marital relationship. Recognizing depressive moods as intervening variables is important because older people tend to deny feeling depressed. Without a conceptual linkage of exchange and depression theories, this pathway would not have been identified.
17 citations
TL;DR: Results provide some evidence that theoretically sound nursing interventions can assist clients to mobilize self-care resources needed to enhance their well-being and suggest that nursing the person rather than the symptom might help people with hypertension contend with stressors, reduce stress, and deal with loss and grief.
Abstract: This study was undertaken to assess the potential for mobilizing self-care resources in 10 persons with hypertension. Modeling and role-modeling theory provided the conceptual base for the experimental group. Ten persons with hypertension were matched with a comparison group. The results provide some evidence that theoretically sound nursing interventions can assist clients to mobilize self-care resources needed to enhance their well-being. Although further research with larger, randomly assigned samples is indicated, these findings suggest that nursing the person rather than the symptom might help people with hypertension contend with stressors, reduce stress, and deal with loss and grief.
TL;DR: The findings of this study suggest a possible developmental delay in coping strategies used by children of alcoholics although no specific ACA role behaviors were identified.
Abstract: Children of alcoholics are often misdiagnosed or ignored because of socially acceptable coping styles. These survival coping mechanisms have been identified as specific role behaviors inhibiting normal development. These assumptions, however, have not been tested with rigorous research techniques. The purpose of this study was to describe the developing role patterns and/or coping behaviors of 30 young adult children of alcoholics (ACAs) between the ages of 18 and 28. Data were obtained primarily through in-depth interviews as well as the Jalowiec Coping Scale. Interview responses were analyzed using content analysis procedures and triangulated with questionnaire responses. The findings of this study suggest a possible developmental delay in coping strategies used by children of alcoholics although no specific ACA role behaviors were identified. Confrontive measures of coping did not develop until young adulthood and only after therapeutic intervention. Two unique methods of coping, reversed emotive and r...
TL;DR: Methods to prevent and correct drug misuse and abuse are discussed and case studies are used to illustrate the complexity of the problem.
Abstract: The elderly are at particular risk for drug misuse and abuse, yet this problem is underdiagnosed Drug misuse is the underuse, overuse, or erratic use of a drug Drug abuse is the use of a drug for other than its intended purpose A thorough nursing assessment is essential to detect and correct drug misuse and to diagnose drug abuse In this paper methods to prevent and correct drug misuse and abuse are discussed Case studies are used to illustrate the complexity of the problem
TL;DR: The development of incest within the family system, the resulting long-term effects, and a treatment model developed by the author to guide therapeutic intervention with the adult female survivor are discussed.
Abstract: As the prevalence of incest survivors seeking therapy continues to increase, clinicians must expand their knowledge and methods of treatment. This article discusses the development of incest within the family system, the resulting long-term effects, and a treatment model developed by the author to guide therapeutic intervention with the adult female survivor. The three-phase Incest Recovery Model provides direction regarding the issues and tasks that each survivor must confront before reaching the therapeutic goals. Phase 1 is conducted in a group setting; Phase 2 in individual therapy and sessions with the survivor's family of origin. Phase 3 concludes with a combination of individual and group sessions. Interruption and reentry of the model may occur at any time; consequently, survivors determine their individual progress. As the psychological burden of incest lessens, survivors are free to adopt healthier patterns of living.
TL;DR: Findings from this study indicated that an effective marital enhancement program at retirement would consider the following factors: changes in roles and identity were significant stressors during this time; the Communication of thoughts was more frequent than the communication of feelings.
Abstract: The focus of this descriptive study was to examine what happens to the marriage at retirement. The data were to serve as a basis for further investigation toward the creation of a marital enhancement program at retirement. Purposeful sampling was used to identify the 10 couples who were involved in the study. Findings from this study indicated that an effective marital enhancement program at retirement would consider the following factors: changes in roles and identity were significant stressors during this time; the communication of thoughts was more frequent than the communication of feelings; spouses became increasingly aware of their partners' faults during retirement; men appeared to be more satisfied in retirement than their wives; hobbies and time spent together did not change following retirement; children served as important topics of conversation and sources of pride and thought; time spent with children following retirement did not increase; and children were often unaware of the challenges and...
Journal Article•
TL;DR: With the development of a reliable and valid instrument that can be used to assess attachment in adults, a better understanding of bonds in older individuals will now be possible.
Abstract: This study describes the development of a reliable and valid instrument that can be used to assess attachment in older adults: the Lipson-Parra Adult Attachment Scale (LAAS). The three-phase design included a critique of the initial 60-item instrument by a panel of experts, a pilot test with 16 respondents, and a field study with 211 respondents ranging in age from 65 to 99 years. The construct validity of the tool was established via factor analysis. A high alpha coefficient of .97 provided strong evidence for its reliability. Significant correlations were found between attachment scores and items regarding residential proximity, contact frequency, and the closeness of the parental relationships. One-way analysis of variance produced significant differences in means according to marital status, number of living children, and living arrangement. Subsequent testing of the revised 20-item LAAS on a sample of 202 respondents provided further support for the reliability and validity of the LAAS. With the development of a reliable and valid instrument that can be used to assess attachment in adults, a better understanding of bonds in older individuals will now be possible.
TL;DR: Because the alcoholic inpatients in the PALS group engaged in altruistic (moral) behavior, this study provides a logical link between the intervention and the outcome, which has been a prevalent weakness in previous studies of self-esteem in alcoholics.
Abstract: This study examined the effect of pairing inpatient alcoholics with nursing home residents (NHRs) on the alcoholics' self-esteem. In this PALS program, the alcoholic inpatients assumed a helping-companion relationship with the NHRs for 2 hr per day during their last 2 weeks of treatment. Fifty alcoholic inpatients were randomly assigned to the PALS program (n = 25) or to the library for free reading time (n = 25). The Tennessee Self-Concept Scale (TSCS) was administered to all subjects in both groups before and after the interventions. Of the nine TSCS scales, the improvement on the Moral-Ethical scale was significantly greater in the PALS group. Because the alcoholic inpatients in the PALS group engaged in altruistic (moral) behavior, this study provides a logical link between the intervention and the outcome, which has been a prevalent weakness in previous studies of self-esteem in alcoholics.
TL;DR: Regression analysis demonstrated that components of behavioral competence, time use and self-rated health, explained 34% of the variance of perceived control.
Abstract: The purpose of this study was to describe the relationship between behavioral competence and perceived control in nursing home elders. The literature strongly supports perceived control as a primary determinant of psychological well-being in nursing home residents. Identifying predictors of this salient variable will enhance the development of interventions to increase and maintain control in nursing home elders. A nonrandom sample of 134 cognitively intact nursing home elders with poor to excellent self-rated physical health was selected fiom 13 nursing homes in four counties of a southeastern state. Instruments used included the Desired Control Measure and the Philadelphia Geriatric Center Multilevel Assessment Instrument. Regression analysis demonstrated that components of behavioral competence, time use and self-rated health, explained 34% of the variance of perceived control. Additional research questions were identified.
TL;DR: Predictors of a health-promoting lifestyle and sexual satisfaction among a group of healthy men were body image, education, and self-esteem, and level of education was the only significant predictor of sexual satisfaction.
Abstract: The purpose of this exploratory, correlational survey was to determine predictors of a health-promoting lifestyle and sexual satisfaction among a group of healthy men. A second purpose was to determine the relationship between these outcome variables within this population. A total of 136 survey packets was mailed to members of two social groups, and 41 completed surveys were returned (33%). Step-wise multiple regression analysis and Pearson product-moment correlations were used to analyze the data. Significant predictors of health-promoting lifestyle were body image, education, and self-esteem (p less than .0001); level of education was the only significant predictor of sexual satisfaction (p = .0223); and the relationship between health-promoting behaviors and sexual satisfaction was significant (r = -.3783, p = .008). Findings have implications for theory development and nursing practice in the area of sexual health.
TL;DR: The involvement of nurses in the assessment, planning, implementation, and evaluation of its services demonstrates success in the redesign and reorganization of community psychiatric services.
Abstract: This article describes the reorganization of one part of an individual, home visiting service for mentally dysfunctional women into a group intervention. Deinstitutionulization has been followed by escalating health care costs, cost containment, and restructuring of services, affecting the already constrained resources for community psychiatric services. Faced with these challenges, a nursing staff, under the administration of a clinical specialist psychiatric nurse, begun reorganization of a home visiting service with one trial group. The model group used the prior success reports of groups that were adapted prospectively with a focus on immediate needs and led by nurses for women. The aims were to enhance social supports of the clients while reducing their relapse rates and to reduce the personnel time and cost. Evaluation found that these objectives were met. Thus, the involvement of nurses in the assessment, planning, implementation, and evaluation of its services demonstrates success in the redesign ...
TL;DR: The Upson-Parra Adult Attachment Scale (LAAS) as mentioned in this paper is a validated instrument that can be used to assess attachment in older adults, which is used for older adults.
Abstract: This study describes the development of a reliable and valid instrument that can be used to assess attachment in older adults: the Upson-Parra Adult Attachment Scale (LAAS). The three-phase design ...
TL;DR: Findings indicated that behavioral management with contingency plans was the mainstay of treatment for the patients regardless of the identified unit treatment philosophy and this approach is effective for patient weight gain within an inpatient setting.
Abstract: This study identifies and describes the inpatient nursing treatment and rationale for patients with anorexia nervosa in nationally recognized psychiatric inpatient settings. The study was undertaken to guide planned change in the nursing protocol on the authors' unit. Sixteen units were surveyed in an extensive telephone interview using structured interview guides. Findings indicated that behavioral management with contingency plans was the mainstay of treatment for the patients regardless of the identified unit treatment philosophy. This approach is effective for patient weight gain within an inpatient setting. Based on these data, the authors concluded that the program which was ongoing at their site was more restrictive than that in most other settings. Changes were made in the unit program to lessen the controls. Objective measures of weight and length of stay indicated that patients do as well with the revised plan as they did with the more controlled plan.
TL;DR: A synthesis of the mid-range theoretical linkages of basic need satisfaction, object attachment, and growth and developmental processes derived from the theory and paradigm provide the basis for describing the dynamic nurse-client relationship.
Abstract: This article describes an example of a paradigm case for the nursing theory of modeling and role-modeling. A synthesis of the mid-range theoretical linkages of basic need satisfaction, object attachment, and growth and developmental processes derived from the theory and paradigm are described. These theoretical linkages guide the assessment, implementation, and evaluation of the nursing care and provide the basis for describing the dynamic nurse-client relationship.
TL;DR: The future possibilities and choices for the new subspecialty, mental health nursing with the elderly, are explored.
Abstract: Although geropsychiatric nursing or mental health nursing with the elderly (MHNE) can be conceived of as a new subspecialty in psychiatric mental health nursing, in essence it is as old as nursing itself, for caring for people of all ages has always been within the purview of nursing. Today, however, in the more developed countries, older adults have increased both in numbers and in sophistication. These two changes have altered mental health care for the elderly. For example, mental health professionals now recognize that the elderly have an image problem which leads to underutilization of existing services. Psychiatric mental health nursing as a whole is questioning the nature of its practice and its place both within academic settings, and within the health care service delivery system. This paper explores the future possibilities and choices for the new subspecialty, mental health nursing with the elderly.
TL;DR: The harmonious accord model, which consists of the concepts of value, movement, and creative expression patterns and operationalizes these concepts in specific nursing assessment and intervention strategies, was implemented on two extended psychiatry units over a 3-year period.
Abstract: A theoretical model derived from the open system nursing principles of Parse, Newman, and Rogers guided the development of a nursing practice application designed to promote the health and quality of life of hospitalized, chronically mentally ill patients. The harmonious accord model, which consists of the concepts of value, movement, and creative expression patterns and operationalizes these concepts in specific nursing assessment and intervention strategies, was implemented on two extended psychiatry units over a 3-year period. This article discusses practice applications of the model, describes the plan for implementation and patient/nurse responses to implementation, and suggests a line of inquiry to eventually evaluate the effectiveness of the model for increasing patient quality of life.
TL;DR: The use of reframing as a means of increasing nurses' choices in their behavioral responses to manipulative patients and an example of how the process might be used to influence nurses' perceptions are discussed are discussed.
Abstract: The use of reframing as a means of increasing nurses' choices in their behavioral responses to manipulative patients and an example of how the process might be used to influence nurses' perceptions are discussed. Perceptions influence nurses' behavioral responses. As individuals, nurses become accustomed to approaching new situations with familiar behaviors, and they lose sight of alternative responses. Choices will expand through the process of reframing, an intervention commonly utilized in therapy situations and a method for challenging the attitudes, values, and responses of a person. Simply defined, reframing is changing a person's interpretation of a given situation and therefore changing his or her behavioral response to it. Expanding nurses' choices is a step toward providing improved patient care.
TL;DR: Discussion topics for outpatient group therapy sessions were rated for importance by 84 psychiatric outpatients from 6 therapeutic groups and 26 psychiatric nurses, supporting the existence of a common goal implicit among therapeutic groups that is known by nurses and augurs well for group cohesion, behavior in accordance with norms, and the efficacy of nurses as leaders of therapeutic groups.
Abstract: Discussion topics for outpatient group therapy sessions were rated for importance by 84 psychiatric outpatients from 6 therapeutic groups and 26 psychiatric nurses. Topics were measured by scales of personal problems and feelings, lifestyle, response to health care, and nonhealth self-disclosure. No significant differences in importance ratings among therapeutic groups or between nurses and patients were found. Scale rankings were the same among patient groups and between nurses and patients, with personal problems and feelings receiving the highest score. Results support the existence of a common goal implicit among therapeutic groups that is known by nurses and augurs well for group cohesion, behavior in accordance with norms, and the efficacy of nurses as leaders of therapeutic groups.
TL;DR: Scientific evidence that sheds light on the disturbances in sexual role performance experienced by chronic alcoholics is discussed within the framework of Roy's adaptation model of nursing.
Abstract: Scientific evidence that sheds light on the disturbances in sexual role performance experienced by chronic alcoholics is discussed within the framework of Roy's adaptation model of nursing. The multiple etiologic factors contributing to disturbed sexual role performance are identified within each adaptation mode, with emphasis on the interrelationships between them. Nursing diagnoses are then suggested.
TL;DR: The concept of the "borderline child" has gained increasing attention in the past few years as mentioned in this paper and new diagnostic criteria are being proposed, and research is attempting to identify the salient features of the syndrome.
Abstract: The concept of the “borderline child” has gained increasing attention in the past JO years. New diagnostic criteria are being proposed, and research is attempting to identify the salient features of the syndrome. This article examines the childhood borderline concept, reviews some new diagnostic systems, identifies the major diagnostic controversies, lists considerations for differential diagnosis, and discusses implications for practice. The intent is to present the state of the art of the diagnosis and to discuss some potential problems with its use. Unique aspects of the childhood syndrome in contrast to the adult disorder are highlighted. Overlap with other disorders, questions about the continuity of symptoms, lack of attention to developmental variables, and countertransference issues are a few of the problems identified.