Showing papers in "Issues in Mental Health Nursing in 1995"
TL;DR: Aspects of alienation-social isolation, loneliness, and lack of solidarity increased for respondents during their lifetime, and positive connections with other people decreased.
Abstract: The purpose of this descriptive study was to explore the experience of alienation from the perspective of a convenience sample of 20 individuals with residual-type schizophrenia. Semistructured interviews focused on general relationships with people and society, feelings of closeness and separation at specified age groups, and experiences of loneliness, social isolation, and lack of solidarity or sense of belonging. Content analysis was performed to categorize qualitative data into concepts from the theoretical framework. Other concepts that increased alienation were stigmas associated with medication and psychiatric treatment, connection to the mental health system, victimization, and abuse. Aspects of alienation-social isolation, loneliness, and lack of solidarity increased for respondents during their lifetime, and positive connections with other people decreased.
64 citations
TL;DR: The major empirical data on religion and mental health that are pertinent to nursing are reviewed, including mental health impact, coping, and aging.
Abstract: As a part of human spirituality, religion has been theorized to influence the health of the individual, both positively and negatively. Although the nursing literature has focused recently on broad aspects of spirituality, the specifics of religious influences on health have been examined cursorily or have been ignored. This article reviews the major empirical data on religion and mental health that are pertinent to nursing. Three areas covered are mental health impact, coping, and aging. Suggestions for future research on the subject are presented.
63 citations
TL;DR: This four-group, repeated-measures experimental design divided 40 healthy professional caregivers/students into high- and low-anxiety groups and further into "therapeutic touch" and comparison groups and the effectiveness of the use of therapeutic touch in reducing anxiety was evaluated.
Abstract: This four-group, repeated-measures experimental design divided 40 healthy professional caregivers/students into high- and low-anxiety groups and further into "therapeutic touch" and comparison groups. The effectiveness of the use of therapeutic touch in reducing anxiety was evaluated, as were the methodologies used. Three self-report measures of anxiety (Profile of Mood States, Spielberger's State/Trait Anxiety Inventory, and visual analogue scales) were evaluated for equivalence and concurrent validity to determine their potential for use in future studies. The correlations among these instruments were highly significant. The small sample size prevented differences between groups from reaching statistical significance, but the reduction of anxiety in the high-anxiety group was greater for those who had received therapeutic touch than for those who did not. Using variability data, the sample size necessary to find statistically significant differences between those who had therapeutic touch and those who did not was determined.
47 citations
TL;DR: A considerable portion of assaults may relate to circumstances that are amenable to intervention, and assaults may be reduced in severity or number by changes in hospital practices.
Abstract: This study compares the viewpoints of psychiatric hospital employees and patients as to situational and interactional factors that are related to patient assaults on staff. Sixty-nine patients from...
41 citations
TL;DR: Stress was the strongest predictor of health in this sample of midlife women, and concerns reported by women in connection with their primary roles differentiated healthiest and least healthy women.
Abstract: Psychosocial variables are not only highly salient to health, but also potentially modifiable if women receive accurate information from care providers. Employing a multivariate multitheoretical ap...
40 citations
TL;DR: Findings revealed that schizophrenia brings about changes in all relationships, but the relationship most affected was that with the ill sibling, which provides a basis for developing sibling-specific interventions.
Abstract: This descriptive field study examined the impact of schizophrenia on 30 adult siblings of patients with schizophrenia. Sibling perceptions of impact on roles, relationships, and health were investigated. Findings revealed that schizophrenia brings about changes in all relationships, but the relationship most affected was that with the ill sibling. Participants experienced grief over loss of the sibling and had difficulty maintaining the relationship. Leisure activities were influenced, as were school and work performance. A significant relationship between health and impact was found. The results of this study provide a basis for developing sibling-specific interventions.
36 citations
TL;DR: Changes in caregiver and family health and in family health behavior patterns were examined 9 weeks after the hospitalization of a child for an acute, first-time illness in a pediatric intensive care unit (PICU).
Abstract: Changes in care giver and family health and in family health behavior patterns were examined 9 weeks after the hospitalization of a child for an acute, first-time illness in a pediatric intensive care unit (PICU). Family and caregiver health included reports of physical, mental, role, and social functioning as well as perceptions of health, pain, and changes in health behavior patterns at 3–7 days after admission to PICU and 9 weeks later. A convenience sample of 20 primary caregivers (all mothers) of children aged 2 days to 17 years served as subjects for the study. Results showed a decrease in mental health scores of all subjects over the 9–week period. Further, those care-givers whose child was rated as having a greater potential for chronicity had a significantly greater decline and were in the range of poor mental health at the 9–week posttest. Seventy percent of subjects reported new health problems in the family posthospitalization, and 43% reported at least one change in family health behavior pat...
33 citations
TL;DR: The results of this study may be used to increase understanding of socially appropriate self-help coping strategies in patients with schizophrenia who experience auditory hallucinations.
Abstract: Even with the best treatment available in the United States, people with schizophrenia often remain troubled by auditory hallucinations. Given the less than optimal results of traditional mental he...
33 citations
TL;DR: The needs, choices, and decisions faced by 38 mothers since becoming HIV-positive are explored and themes that emerged illustrated that decisions and choices, uncertainty, their relationship to their children, and a renewed spirituality influenced the actions that they took in response to their HIV- positive status.
Abstract: Despite the increasing prevalence of human immunodeficiency virus (HIV) infection in the female population the responses of women to their HIV-positive status and their resultant needs remain largely unexplored. This investigation explored the needs, choices, and decisions faced by 38 mothers since becoming HIV-positive. Participants were recruited from an infectious disease clinic in a large mid-Atlantic urban area. The results are based on data from taped, semistructured interviews with participants. Themes that emerged from these verbal reports illustrated that decisions and choices, uncertainty, their relationship to their children, and a renewed spirituality influenced the actions that they took in response to their HIV-positive status. Themes are discussed in relation to needs for further research and health-related interventions.
33 citations
TL;DR: The purpose of this paper is to further the understanding of three control models by describing their origins, definitions, generality, process, antecedents, and consequences within a case study of a 98-year-old Caucasian woman living in a nursing facility.
Abstract: The purpose of this paper is to further the understanding of three control models by describing their origins, definitions, generality, process, antecedents, and consequences. Each is applied to a clinical situation within a case study of a 98-year-old Caucasian woman living in a nursing facility. Similarities and differences among the models are reviewed. Implications for clinical practice and research are presented.
32 citations
TL;DR: Data is examined from two studies that included information about the use of social support by abused women during their stay in a transition house that revealed a potential for problems when vulnerable clients offer support to other vulnerable clients.
Abstract: Research has demonstrated clearly the positive effect social support can have on health. Peer-provided social support, in the forms of both one-on-one peer counseling and peer support groups, is encouraged by health care providers as an effective and inexpensive way to enhance mental health in at-risk client populations. This article examines data from two studies that included information about the use of social support by abused women during their stay in a transition house. Analysis revealed a potential for problems when vulnerable clients offer support to other vulnerable clients. The ability to offer support was viewed by the “givers” to be evidence of their own recovery. Women needed to give this support, and, therefore, it was often difficult to know whose needs were being met. The complexities of these relationships are discussed. An understanding of the issues involved will ensure that maximum benefit with minimum risk can be derived by participants in supportive exchanges between peers.
TL;DR: This qualitative research report presents an illustration of Mishel's (1990) reconceptualization of uncertainty in illness theory applied to persons with schizophrenia.
Abstract: This qualitative research report presents an illustration of Mishel's (1990) reconceptualization of uncertainty in illness theory applied to persons with schizophrenia. The researcher interviewed 6 persons with schizophrenia and 5 family members. The informants reported being uncertain about whether their medicine would keep working, whether they would be able to provide for their children, whether they could stay on their medicine, whether their symptoms would improve, when the next relapse would be, and even whether they would survive. They appeared to be experiencing differing degrees of uncertainty and a variety of manifestations of probabilistic thinking. For some, uncertainty provided the opportunity for hope. For others, the uncertainty was perceived as a danger. For all of them, their view of life had changed.
TL;DR: The purpose of this paper is to explicate the concept of learned resourcefulness through the examination of its uses and consideration of model, borderline, related, contrary, and illegitimate cases.
Abstract: Resourcefulness is an important phenomenon in promoting adaptive functioning in individuals experiencing depressive illness. A review of nursing and related literature reveals increasing interest in the usefulness of learned resourcefulness. However, the theoretical and empirical literature also addresses several other phenomena of concern to nurses that seem similar or related to learned resourcefulness. The process of concept analysis provides a useful approach for examining important phenomena and clarifying similarities and differences from related concepts. The purpose of this paper is to explicate the concept of learned resourcefulness through the examination of its uses and consideration of model, borderline, related, contrary, and illegitimate cases. As a result, the defining attributes, antecedents, consequences, and empirical referents are identified. Theoretical, methodological, and clinical implications related to the concept of learned resourcefulness are also discussed.
TL;DR: The investigators discuss the findings of the study from the perspective of the Mexican American culture, followed by specific conclusions and recommendations drawn from the results.
Abstract: This study was conducted to determine the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teens. The research question was: What are the magnitude of the relationships between suicidality and life stress, coping, depression, and family dysfunction in Mexican American teenagers? The investigators discuss the findings of the study from the perspective of the Mexican American culture, followed by specific conclusions and recommendations drawn from the results of the study. In this article, the term teen is used interchangeably with the terms teenager, youth, and adolescent; suicidality is used interchangeably with suicide risk.
TL;DR: Based on the findings, becoming and being courageous is a lifelong process that includes a variety of learning experiences and problem solving is involved, and it is thought to enable the transformation of struggles into challenges.
Abstract: This grounded theory study was conducted to develop a conceptual framework of courage in the chronically ill elderly. Theoretical sampling was utilized, and 21 individuals who were 67 to 94 years of age were interviewed. The interviews were audio-recorded and transcribed verbatim. Data analysis was conducted using the constant comparative method.Based on the findings, becoming and being courageous is a lifelong process that includes a variety of learning experiences. Problem solving is involved, and it is thought to enable the transformation of struggles into challenges. Courageous behaviors are identifiable, and can be maintained with the help of nursing interventions. Outcomes of being courageous include a sense of equanimity and personal integrity.
TL;DR: Compared the perceptions of assaultive patients and staff victims regarding assault incidents, Monahan's (1981) framework was used for assessing violence on the assaultive patient and the assaulted staff member.
Abstract: The purpose of this study was to compare the perceptions of assaultive patients and staff victims regarding assault incidents. The hypotheses were as follows : (1) There will be congruence between patients' and victims' reports of objective or factual information regarding the assaults and (2) there will not be congruence between patients' and victims' reports of subjective information about the assaults. Monahan's (1981) framework was used for assessing violence on the assaultive patient and the assaulted staff member. Patients who assaulted a nursing staff member and nursing staff members who were assaulted were interviewed, and the congruence of responses between each pair (patient and staff member) on each question was assessed. For 10 items designated as objective, there was agreement between patients and victims in 6 cases and disagreement in 4 cases. For 8 subjective items, in all cases patients and victims gave different perceptions.
TL;DR: Depressed wives seemed to maintain their depression over time if they perceived family life as stressful, and irrespective of marital problems, husbands were less likely to stay depressed.
Abstract: This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.
TL;DR: Psychiatric nurses are well aware of violence against women, and this article provides another level of understanding of the effects of violence and trauma on a woman who kills in response to violence.
Abstract: Only 12% of all homicides in the United States are committed by women (Browne & Williams, 1989; Jones, 1981), and the majority of these women are killing their abusive and violent partners. The woman who has killed her partner is now a criminal defendant, which adds a very complicated dimension to her plight. The battered woman who kills her assaulter is additionally handicapped by a legal system that lacks consensus concerning the proper legal response to her case. Maguigan (1991) estimates that there are about 750 men killed each year by wives, girlfriends, and lovers, and argues that the female homicide defendant is almost always a battered woman. When a battered woman becomes a defendant in a criminal case it becomes crucial for the introduction of psychological information about the dynamics of her circumstances to be presented in a court of law so that her actions can be understood by those judging her behavior. Nurses, particularly psychiatric nurses, may be in critical positions as expert witnesses, therapists, and crisis counselors to assist the battered woman and her legal representative in developing a comprehensive understanding of her response to her violent partner. Psychiatric nurses are well aware of violence against women, and this article provides another level of understanding of the effects of violence and trauma on a woman who kills in response to violence.
TL;DR: How solution-focused therapeutic modalities are used in the continuum of care is described, which means that clients with psychiatric needs are likely to have both fewer and briefer inpatient hospitalizations.
Abstract: The shift to a managed care philosophy means that clients with psychiatric needs are likely to have both fewer and briefer inpatient hospitalizations. Identification of focused goals and measurable...
TL;DR: The philosophical assumptions that underlie the brief inpatient program are described and how solution-focused therapeutic modalities are used in the continuum of care is described.
Abstract: The shift to a managed care philosophy means that clients with psychiatric needs are likely to have both fewer and briefer inpatient hospitalizations. Identification of focused goals and measurable outcomes may not translate easily into inpatient programs that have been more process oriented or have based definitions of improvement on complete or near-complete remission of the admission diagnosis. In the context of these shifts, nursing's focus on maintaining a safe environment, developing a therapeutic relationship, providing information, and valuing holistic and individualized care may be lost in programs that treat all clients in the same “packaged” programs. This article describes the philosophical assumptions that underlie the brief inpatient program. The next article in this issue describes how solution-focused therapeutic modalities are used in the continuum of care.
TL;DR: Patients were restrained supine or prone to see how quickly behavior was brought under control and the fewer hours that patients were restrained was presumed to be more therapeutic, with supine being the longer.
Abstract: Restraints have been used to immobilize the mentally ill since the Middle Ages. However, no one has addressed restraint position as an important factor in outcome. In this study, 20 patients (25 trials) were restrained supine or prone to see how quickly behavior was brought under control. The fewer hours that patients were restrained was presumed to be more therapeutic. The difference between supine or prone restraint was 3.2 hours, with supine being the longer. The difference was nonsignificant. Despite statistical nonsignificance, the difference was believed to be important for nursing staff.
TL;DR: This study was conducted to refine the theoretical basis for interventions related to self-concept and woman abuse for rural Mexican American and non-Hispanic white women.
Abstract: The prevalence of woman abuse has serious community health ramifications because of its associated psychological responses. Theoretical frameworks have described behaviors arising from interpersonal interactions as being affected by self-concept. Therefore, assessing self-concept is critical in research and practice for understanding the behavior of abused women and the effects of self-concept on the physical self. This research arose from clinical practice in a rural Mexican American and non-Hispanic white community. The practice focused on individual and group counseling for women and adolescents in abusive relationships. This study was conducted to refine the theoretical basis for interventions related to self-concept and woman abuse for rural Mexican American and non-Hispanic white women.
TL;DR: Results of a consultation survey collected as part of a larger geriatric mental health training project, and described in this article, support the position that consultee-centered geropsychiatric nursing consultation services are an important adjunct to training.
Abstract: Creative, collaborative approaches between sub-specialties in nursing are needed to improve the quality of care and, hence, the quality of life for mentally ill and behaviorally impaired older adults living in long-term care (LTC) facilities. Results of a consultation survey collected as part of a larger geriatric mental health training project, and described in this article, support the position that consultee-centered geropsychiatric nursing consultation services are an important adjunct to training. However, this indirect approach to service enhancement may not be well understood and, as a result, not well utilized by LTC nurses. Methods to facilitate understanding and utilization of "indirect" mental health assistance to LTC residents and staff are explored within the context of building productive liaisons among nurses.
TL;DR: Using a modification of the concept analysis approach proposed by Walker and Avant (1988), a detailed description of differentiation of self is presented, delineating it from similar concepts.
Abstract: Differentiation of self is a concept that has been used interchangeably with the similar concepts of individuation and psychological differentiation. The construction of a sound empirical knowledge base for differentiation of self has been hindered by the lack of conceptual-operational fit found in many studies. Using a modification of the concept analysis approach proposed by Walker and Avant (1988), a detailed description of differentiation of self is presented, delineating it from similar concepts. Differentiation of self is defined as the ability to distinguish between thoughts and feelings in an emotional relationship system. As the cornerstone concept in the Bowen theory (1985b), knowledge about differentiation of self has important clinical implications for nurses and other health professionals who strive to improve the assessment and intervention process in their work with individuals and families.
TL;DR: An analysis of the concept empathy was performed on archival, narrative accounts of Civil War nursing care using concept analysis strategies, noting the existence of nursing interventions as a critical attribute and the nature of patient responses.
Abstract: An analysis of the concept empathy was performed on archival, narrative accounts of Civil War nursing care using concept analysis strategies. Archival model cases are presented with elucidation of critical attributes, antecedents and consequences, and empirical referents of the concept. The antecedent phenomena of patient cues and consequent phenomena of patient responses serve to clarify instances of nurse empathy and establish preliminary and terminal boundaries of the concept. Empirical referents of the critical attributes identification, introjection, and intervention further explicate this abstract construct. Analysis of contrary, related, and borderline cases extracted from the historical accounts serve to clarify empathy. Most notable to the analysis is the existence of nursing interventions as a critical attribute and the nature of patient responses. Preliminary examination of the model cases indicates patient outcomes improve when empathy is extant in the interaction.
TL;DR: Findings suggest that most participants found relocation to the community easy and a strong interest in participating in health promotion programs including exercise, stress management, and smoking cessation programs.
Abstract: This article describes findings from a community assessment project on 25 chronically mentally ill individuals who rejoined the community following discharge from psychiatric hospitals. The focus was to identify health concerns or problems and health promotion patterns using Healthy People 2000 as a guiding framework. Findings suggest that most participants found relocation to the community easy. Stress, depression, and abuse were mental health problems reported by participants. Physical health problems included high tobacco use, low exercise level, poor oral health, high-risk sexual behavior, and limited contact with physicians and dentists. Health promotion activities were good sleeping behavior, limited use of alcohol and drugs, and a strong interest in participating in health promotion programs including exercise, stress management, and smoking cessation programs. Interventions to promote the health of the chronically mentally ill and implications for community mental health nurses are discussed.
TL;DR: Students reflected on the image of nurse as tour guide and discovered theory being lived out in practice, new ways of understanding the role of the nurse, appreciation for the individual approach in nursing, and a new confidence in sharing and creating.
Abstract: This article responds to the call by Heinrich (1992) to harness the power of metaphor to reenergize nursing classrooms. An overview of the power of metaphor is provided, as well as a description of a learning activity that prompted students to think metaphorically about a nursing experience. Students reflected on the image of nurse as tour guide and discovered theory being lived out in practice, new ways of understanding the role of the nurse, appreciation for the individual approach in nursing, and a new confidence in sharing and creating.
TL;DR: A survey of psychiatric nurses in the state indicates the need for specialized knowledge and skills to provide care to mentally ill clients with increasingly complex problems, additional nursing involvement in political and health care arenas, and more nursing leadership and support within nursing.
Abstract: Concerned about the status of both mental health services and the role of professional nursing in the delivery of those services, the Michigan Nurses' Association Psychiatric—Mental Health Nursing Practice Section initiated a survey of psychiatric nurses in the state. One hundred forty psychiatric nurses returned questionnaires that explored their professional characteristics and activities, the characteristics of their clients, their perceptions of major issues confronting mental health services and psychiatric nursing and recommended actions, the perceived strengths of psychiatric nursing, and the skills and knowledge they believed are necessary for the future. Respondents are working with a variety of patients in difficult circumstances. Responses indicate the need for specialized knowledge and skills to provide care to mentally ill clients with increasingly complex problems, additional nursing involvement in political and health care arenas, and more nursing leadership and support within nursing.
TL;DR: More research is needed to validate the effectiveness of IOC and to determine when IOC is justified to support an individualized treatment program.
Abstract: Involuntary outpatient commitment (IOC) in some form has been adopted by all states as an alternative to hospital commitment. Regulations for IOC vary among the states. Although some studies have shown that IOC reduces hospital admission rates, research findings have not clearly determined the effectiveness of IOC or the type of concurrent care measures indicated. The limited community care available for IOC patients, the legalities, and the ethical issues surrounding the restriction of a client's autonomy and self-determination are rarely addressed. Nurses need to be prepared to advocate for patients who may be at risk for violation of their basic rights. More research is needed to validate the effectiveness of IOC and to determine when IOC is justified to support an individualized treatment program.
TL;DR: The perceptions of 43 adult male sex offenders were examined to generate a grounded theory of the sexual abuse treatment process and remodeling as a metaphor offers a concrete, visual, individualized, and safe way to address the treatment process of sex offenders.
Abstract: The perceptions of 43 adult male sex offenders were examined to generate a grounded theory of the sexual abuse treatment process. Methodology included interviews, direct observations, and record analysis. Constant comparative analysis was used to collect and analyze data concurrently. The offenders use remodeling as a metaphor for their treatment process; they remodel themselves, their relationships, and their environment, but the foundations of offending are ever present. The remodeling process involves falling apart, taking on, tearing out, rebuilding, doing the upkeep, and moving on. Remodeling as a metaphor offers a concrete, visual, individualized, and safe way to address the treatment process of sex offenders.