Showing papers in "Issues in Mental Health Nursing in 1994"

Factors Related to Nursing Burnout A Review of Empirical Knowledge

Abstract: It has been observed that nurses are at a high risk of burnout The initiator variables of burnout appear to be numerous, tenacious, and not isolated; burnout is a complex phenomenon with multiple

Effect of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China

Abstract: The purpose of the study was to examine the effectiveness of assertiveness training in improving self-perceived levels of stress and assertiveness among nurses in Taiwan, Republic of China. The two-group experimental design was conducted in a 2,000-bed veteran general hospital. A sample of 60 volunteer Chinese-speaking nurses participated in the study. Subjects were randomly assigned to one of two treatments: assertiveness training (AT) or alternate treatment control (ATC), which served as a control and contained updated knowledge of new computer technology for in patient settings. Subjects in each group participated in six 2-hour workshops in the same two-week period. All subjects were pre-, post-, and follow-up posttested for stress and assertiveness with the Perceived Stress Scale (PSS) and Rathus Assertiveness Schedule (RAS), respectively. Results revealed the following: (1) subjects in both groups of pretest were clearly subassertive and under considerable stress; (2) by the end of training, the AT group scored significantly higher on the rating of assertiveness than those in the ATC group, and had successfully maintained their improvement by the 4-week follow-up; and (3) by the end of training, the AT group reported significantly lower levels of stress than the ATC group as indicated on the PSS, and successfully maintained their improvements at the 4-week follow-up. Overall, the results indicate clear support for the effectiveness of assertiveness training for treating subassertive behaviors and stress in a population of professional nurses in Taiwan.

Environmental characteristics related to patient assault

Abstract: Environmental factors related to physical assault by patients were examined to identify clinical implications warranting further investigation and to test methodology. The concepts of ward conditio...

Prevention research program: reconnecting at-risk youth

Abstract: This research program focuses on some of society's most profound problems: adolescent drug involvement, school failure, and suicide behaviors. The program goals address several interdisciplinary research challenges: (a) testing theory-driven preventive interventions focusing on the multifaceted etiology of adolescent drug involvement and suicide potential; (b) targeting potential school dropouts from a distinctly underserved high-risk population; and (c) integrating preventive interventions into school-based programs that utilize a multidisciplinary team of clinicians and researchers. Three sets of studies are described; they illustrate how ethnographic, experimental, and causal modeling designs and methods were intricately woven in successive theory construction and testing steps. Ethnographic and etiologic studies revealed a profile of vulnerabilities in personal, peer, family, and school contexts. Instrumentation studies led to reliable and valid process and outcome measures of key constructs. Tests of...

Chinese Perspectives on Culture and Mental Health

Abstract: Central to providing culturally appropriate nursing care is sensitivity to and knowledge about the group being cared for. Although "mental health" and "mental illness" are artificial concepts among people who do not differentiate and treat mind, body, and spirit separately, and who may not differentiate illness from other problems of living, many individuals ethnically rooted in one or more Asian cultures enter Western mental health care systems. Quality nursing care requires understanding and respect for traditional values, beliefs, and practices that may differ significantly from those typical of Western European-based societies. Whether clients are traditional in orientation or highly acculturated to Western ways, nurses are responsible for providing culturally appropriate care. This article discusses mental health and nursing care from various perspectives of Asian and Asian-American clients, and in particular those of Chinese descent.

Coping with Chronic Sorrow

Abstract: This qualitative study was designed to examine the presence of chronic sorrow in diverse populations of individuals with chronic or life threatening conditions and to identify strategies for coping...

Anxiety and self-care following myocardial infarction.

Abstract: The purpose of this study was to examine the relationship between trait and state anxiety experienced during hospitalization for an acute myocardial infarction and self-care behaviors several weeks after the infarction. Sixty-two male (n = 39) and female (n = 23) subjects were interviewed during their hospital stay and again 3 months after discharge. State and trait anxiety were measured by the Spielberger State-Trait Anxiety Inventory Test. Medication, exercise, smoking, diet, and stress management self-care were measured by Miller's Health Behavior Scale. The findings revealed low correlations between trait anxiety and exercise performance, medication administration, stress management, and smoking cessation behavior, and between state anxiety and smoking behavior. The findings were interpreted in light of the conceptual differences between state and trait anxiety, and suggest that mental health interventions during hospitalization should emphasize teaching patients to manage their own anxiety instead of directly intervening to reduce current levels of anxiety among this population.

Persistent and Severely Mentally Ill Clients' Perceptions of Their Mental Illness

Abstract: This qualitative, exploratory study examines severely mentally ill clients' perceptions of their illness and the effects of this illness on their lives. The major purpose of this study was to explore the lived experiences of severely mentally ill clients. Subjects included 15 clients in an out patient mental health clinic in a veterans' hospital in the upper midwestern United States. A phenomenologic methodology was used, with subjects being interviewed until common themes emerged. The data were analyzed utilizing a seven-step method. Four major themes emerged in the data analysis. Identification of these themes provided a meaningful way to synthesize the data and identify those concepts that best capture and name the personal perceptions of severely and persistently mentally ill people. The four themes identified were stigmatization and the resulting alienation, loss, a pervasive feeling of distress, and acceptance on two dimensions (a personal acceptance of having a mental illness and a need for accepta...

Veterans' Responses to Anger Management Intervention

Abstract: Anger management intervention is an integral part of posttraumatic stress disorder (PTSD) treatment in the Department of Veterans Affairs facilities across the country. However, the efficacy of suc...

Depression Among Chinese Americans: A Review of the Literature

Abstract: The Chinese American population is among the fastest growing ethnic minority groups in the United States. Knowledge of the interaction between culture, disease expression, and utilization of psychiatric treatment by this population is limited. This article gives a general review of the literature on depression among Chinese Americans in order to clarify misconceptions, to increase knowledge of research on depression that has been done on one specific Asian-American group, and to set a direction for future nursing research and intervention.

Operationalizing Maslow's Theory: Development and Testing of the Basic Need Satisfaction Inventory

Abstract: Although Maslow's theory is frequently cited in the nursing literature and is commonly used as an underlying framework for clinical practice, it has been subjected to limited empirical scrutiny. This may be due, in part, to a scarcity of survey measures to operationalize the construct of need satisfaction. The Basic Need Satisfaction Inventory (BNSI) was developed for this purpose. The instrument, created from Andrews and Withey's indicators of life concerns and their “delighted-terrible” scale, was first examined through secondary data analysis, pilot tested (N = 21), and then administered to samples of men and women with chronic pulmonary disease (N = 109) and healthy older adults (N = 100). Emerging evidence of internal consistency reliability and construct validity suggests that the BNSI may be a useful instrument to measure need satisfaction and to test the adequacy of Maslow's theory for nursing science and practice.

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities

Abstract: Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

When your client lives in a rural area. Part I: Rural health care delivery issues.

Abstract: In the past 2 years there has been increased emphasis on health care delivery concerns in rural environments Research monies also target the health care needs of vulnerable populations living in areas with a shortage of health professionals; many of these populations are located in rural areas There is, however, a paucity of information about populations and mental health nursing in rural environment Part I of this two-part article summarizes pertinent definitions and characteristics of rural environments The health care delivery system in rural settings is considered within a framework of availability, accessibility, and acceptability of services Traditional belief systems are highlighted, and the impact of these on health care-seeking behaviors of rural people are discussed

Reactions to Chronic Low Back Pain

Abstract: Using a phenomenological approach, the meaning of chronic low back pain to 15 individuals was examined. Interviews were conducted and analyzed and six distinct areas were identified. The focus of this presentation is limited to altered interactions and varied psychological reactions, including a negative response toward others, a desire to maintain independence, and a belief that the pain being experienced is real. The individuals experienced social isolation, enhanced awareness of others experiencing pain, and varied psychological reactions. The presence of pain affects individuals physically, but the meaning to the individual and the impact on his or her life is more far-reaching.

Brief Hospital Treatment Plans: Innovations in Practice and Research

Abstract: Hospital care for persons with mental health problems has changed dramatically in the past two decades. The emphasis on community-based models of care, cost containment, and the concern that psychiatric hospitalization may be ineffective or even harmful for some clients has led to the development of innovative hospital treatment programs. In this paper, the author examines a brief hospital treatment program developed for persons who have been identified, either previously or currently, with borderline personality disorder. The typical features of brief hospital plans, the lived experiences of five participants, and the changes in hospital utilization before and after the involvement in the program are discussed. The findings reveal the benefits as well as the limitations of this innovative program in improving the day-to-day lives of people with mental health problems. The methodology and results of this study provide direction for innovation and diversification in psychiatric nursing practice and research.

Social support: conceptual and methodological issues for research in mental health nursing.

Abstract: The concept of social support has been the focus of growing multidisciplinary interest over the past two decades. Nurses are interested in the role that social support plays in promoting mental hea...

Symptoms of Female Survivors of Child Sexual Abuse

Abstract: Women who suffered sexual abuse as children often experience a variety of physical and psychosocial symptoms as adults. Identifying this pattern of symptoms might assist health professionals in recognizing and treating non reporting survivors of child sexual abuse. In this study, the Adult Survivors of Incest (ASI) Questionnaire (Brown & Garrison, 1990) was used to determine the symptoms and contributing factors for 22 adult survivors of child sexual abuse. Six physical symptoms were experienced by 50% of the subjects, and over 75% of the subjects experienced II psychosocial symptoms. The number of physical symptoms correlated significantly with other victimizations (r = 59) and number of psychosocial symptoms (r = 56). The findings suggest that the ASI Questionnaire was effective in identifying patterns of symptoms and contributing factors of adult survivors of child abuse. Additional study is needed to determine the usefulness of this questionnaire in identifying non reporting survivors in clinical situ...

Codependence: contextual variables in the language of social pathology

Abstract: The concept of codependence is examined. The history of the term is reviewed, and definitions from the current literature are given. Characteristics of codependence are listed, including denial, control, difficulty in trusting, low self-esteem, weak boundaries, and overresponsibility. Theories concerning the genesis of this condition are described. Problems with the concept are detailed, and questions for further study are generated. The conclusions support the need for caution in labeling and for recognizing the potential for misusing concepts that are in the early stage of development.

Wellness Education for Individuals with Chronic Mental Illness Living in the Community

Abstract: The article reports a wellness education program developed to enhance and promote healthy life-style behaviors for individuals with chronic mental illness living in the community. Theoretical concepts from health promotion, wellness, and social learning were used in the development of this program. The program comprised three components: wellness education sessions, exercise/activity sessions, and a smoking reduction course.

Mental health of rural elderly: A Research agenda for nursing

Abstract: Only recently have the health sciences, including nursing, begun to focus on the dynamics of mental health and aging. Reports on rural initiatives, are beginning to appear; these developments have occurred without the benefit of context and direction, however, especially in terms of how these issues apply in rural areas. The article reviews selected issues in the interface of aging and mental health in rural areas. It offers a research agenda comprising descriptive, intervention, and utilization studies as a context to guide research and knowledge development in mental health nursing of rural elderly.

Review of Adolescent Coping Research: Representation of Key Demographic Variables and Methodological Approaches to Assessment

Abstract: Stressful experiences can be traced to surrounding social structures, the most encompassing of which include gender, socioeconomic status (SES), and race. An integrative review of adolescent coping research was conducted to examine the inclusion of key demographic variables and methodological approaches to the assessment of coping. Results indicated that the majority of studies investigated coping among both gender groups. However, only 46.7% reported information on SES. Coping among adolescents of lower SES and the inner city was not adequately examined. Similarly, only 53% of the studies reported information on racial composition. African-American and other minority adolescents were underrepresented in the research. To assess coping, 73.3% of the studies utilized the questionnaire format. However, instruments were not used in a consistent manner with regard to the period of time from which to recall a stressor and the context from which the stressor was selected. For those using the open-ended format for assessment, data were analyzed exclusively via the deductive approach. Our findings suggest that future research should (a) investigate coping among youth from diverse SES and racial groups, (b) examine coping over a full range of stressors, (c) utilize daily reports, and (d) assess coping by applying qualitative methods.

Mental health outreach program following the earthquake in Armenia: utilizing the nursing process in developing and managing the post-natural disaster plan.

Abstract: This article provides a description of the eight phases of the Mental Health Outreach Program (MHOP) cofounded by the author to address the needs of the surviving community following the 1988 earthquake in Armenia. For the purposes of the MHOP, the nursing process was expanded from five to eight phases: 1) preassessment, 2) assessment, 3) analysis, 4) community diagnosis, 5) planning, 6) implementation, 7) evaluation, and 8) remodification. A framework for assessing the level of trauma in an unfamiliar community (with its mnemonic acronym COPE,), which was formulated by the author to expedite the assessment and implementation phases, is described. The article concludes with a set of recommendations for psychiatric mental health nurses in mitigating the negative impact and consequences of disasters.

Congruence between aggressive behavior and type of intervention as rated by nursing personnel.

Abstract: In this pilot study, nursing staff matched three levels of intervention (verbal, chemical, and physical) with 84 aggressive behaviors. It was a preliminary step in the development of a theoretical framework regarding how nurses select interventions for aggressive patients. Specifically, it was an attempt to address the following: Do nurses intervene with aggressive behaviors based on learned stereotypes or do nurses perceive behavior as aggressive because there is consistency in the behavior and level of aggression? All 442 members of the nursing staff were invited to participate in the study; and 211 (48%) responded. Factor analyses were conducted on responses to the behaviors of subjects matched with each intervention. The same three factors were identified for verbal and chemical intervention: behaviors that are precursors to an actual aggressive episode, aggressive behaviors directed inwardly, and aggressive behaviors directed outwardly. The last two behaviors were also identified for physical interve...

Nursing Model of Psychoeducation for the Seriously Mentally Ill Patient

Abstract: The purposes of this paper are to describe a nursing model for psychoeducation that is being implemented in the psychiatric unit of a Veterans Administration (V.A.) Hospital and to report baseline descriptive data for 19 seriously mentally ill patients. The data were collected as part of a larger study of patient, family, and treatment variables associated with community adjustment of seriously ill psychiatric patients. A convenience sample of 19 consenting patients with DSM-III-R diagnoses of schizophrenia, schizoaffective disorder, or bipolar disorder were interviewed and assessed by a clinical nurse specialist. Nine consenting family members, identified by the patient as a key family member, were also interviewed. The baseline data reported here were generated in these interviews. These data were also used to develop psychoeducational plans to meet individual patient/family needs. The patients had had an average of 12 prior hospitalizations. Their mean age was 38 years; 74% were African-American and 89% were male. Patients reported a variety of understandings of the reason for their hospitalization and techniques for management of their symptoms. The most common ways of managing symptoms were categorized as physical activity, decreasing stimuli, and use of alcohol/drugs/smoking. Practical problems arising in association with the conduct of clinical research in a V.A. psychiatric setting by a research team are also discussed.

When your Client Lives in a Rural Area Part II: Rural Professional Practice—Considerations for Nurses Providing Mental Health Care

Abstract: Part I of this two-part article examined the rural health care delivery system within the framework of availability, accessibility, and acceptability of services. Traditional rural values were explored in relation to ruralities' health care-seeking behaviors, specifically mental health care. Part II highlights the opportunities and challenges of rural professional practice, particularly as they apply to nurses caring for those with emotional problems who need mental health services. Strategies are suggested to enhance the continuum of care for clients who live in environments with sparse resources.

Chaos, perfectionism, and sabotage: personality disorders in the workplace.

Abstract: Psychiatric nurses work in a variety of settings as supervisors, administrators, and consultants. They understand that success or failure of organizational activities depends in large measure on the staff's productivity, commitment, and cooperation. When these qualities are absent, major problems can ensue. This paper uses a case study approach to examine the impact that employees with borderline, obsessive-compulsive, and passive-aggressive personality disorders have on organizations. Specific disruptive behaviors that can challenge co-workers and negatively affect the effectiveness of the work group are presented. Therapeutic strategies are identified that have been adapted for use in the workplace. These strategies are used to help employees perform in a more effective manner while minimizing maladaptive responses to guidance and supervision.

A Delphi Study to Determine Defining Characteristics of Interdependence and Dysfunctional Independence as Potential Nursing Diagnoses

Abstract: Nurses deal with human behavior and are often responsible, not only for their own interpersonal behavior but also for assessment, analysis, and interventions relative to the behavior of clients. This exploratory study was designed to elicit responses from certified psychiatric-mental health clinical nurse specialists relative to the defining characteristics of interdependence and dysfunctional independence. A Delphi methodology was used to obtain a total of 10 defining characteristics for interdependence and 13 defining characteristics for dysfunctional independence. Three operational definitions were obtained for each of the characteristics from the ratings of nurses who contributed information based on the behaviors of their own clients. These characteristics are the basis for future studies relating to dependence, independence, and interdependence.

State university collaboration to transform practice in public sector psychiatric nursing.

Abstract: In 1986 and again in 1988, Hawaii was ranked by the Torrey report as being 51st in the nation in caring for its persistent and seriously mentally ill. After several years of being ranked last in the nation, and with the threat of a consent decree from the U.S. Department of Justice, the state of Hawaii made a commitment to improve the psychiatric mental health care of its citizens. The state's Department of Health, in September 1990, contracted with the University of Hawaii's School of Nursing to provide joint appointment faculty to consult with the nursing staff and to provide the department's chief of nursing. Working together with the joint appointment faculty, the permanent staff began the journey toward creating a state-of-the-art facility. The article discusses how change of such magnitude has been created.

Adolescent suicide: behaviors, risk factors, and psychiatric nursing interventions.

Abstract: Current statistics show a marked increase in suicides among adolescents 15 to 19 years of age. The literature suggests an increase in the use of lethal methods such as firearms by young suicide attempters. Studies show that most adolescent suicide completers have never received mental health treatment, although the majority had exhibited psychiatric symptoms previous to their deaths. This review of the literature identifies the characteristics and precipitants of suicidal behavior among adolescents. The literature clearly indicates a need for suicide awareness and prevention programs and for the early identification of teenagers at risk for suicidal behaviors. The most logical location for suicide prevention programs and activities is in the schools where the greatest number of adolescents can be reached. The master's-prepared psychiatric mental health nurse in a consultive and collaborative role can be instrumental in the successful formation and execution of these programs. In a joint effort, school personnel and the psychiatric mental health nurse specialist may be able to decrease significantly the number of suicidal behaviors among adolescents.

Psychosocial triggers of relapse in persons with chronic mental illness: a pilot study.

Abstract: An exploration of the events preceding a relapse in patients with a chronic mental illness was conducted to determine if these events could have been managed more effectively to prevent the relapse...