Showing papers in "Journal of Child and Adolescent Psychiatric Nursing in 1992"

The effect of a bereavement group experience on bereaved children's and adolescents' affective and somatic distress.

Abstract: Losing loved ones through death is a common experience for children. Children living in urban centers may be at greater risk for death of family members as a result of increased daily stress and poverty. Children who experience permanent loss of family members without support to grieve are at greater risk for mental health problems. Manifestations of grief that frequently occur in children are psychosomatic complaints and affective distress. This study investigates the prevalence of loss by death among two groups of inner city youths, and the impact of a bereavement group experience on subjects' affective distress and somatic complaints. A significant difference was found between pretest and post-test scores on somatic complaints for the elementary school aged group.

Sibling incest: a descriptive study of family dynamics.

Abstract: This study investigates the characteristics of families in which a member was identified as a victim of sibling incest. Four agencies in a southeastern city provided a convenience sample of 14 family case records from November 1986 through April 1988 for review. Sixteen children were identified as victims of sibling incest, including three boys and 13 girls between the ages of 2 and 10 years (mean = 6.75 years). Perpetrators included 1 girl and 14 boys between the ages of 13 and 17 years (mean = 15.06 years). The incestuous relationship had a major impact on families, especially the children. Many offenders and victims, in addition to experiencing emotional, school, and legal problems, were removed from their homes.

Children's Concepts of the Mentally III

Abstract: One hundred sixty-eight children in grades three through six were asked to read vignettes describing the problematic behaviors of mentally ill children and adults. The schoolchildren then labeled the characters, attributed causes and motivations to their behaviors, and suggested possible treatments. Although only 27% of the children labeled vignette characters as mentally ill and 11% recommended psychiatric interventions, all the children recommended some kind of intervention. While slightly fewer than one-third (29%) of the children suggested that an adult intervene in some nonpsychiatric manner, 60% recommended some kind of child-initiated activity as an intervention. A developmental trend was evident in children's attribution of mental illness labels and recommendations for both psychiatric and adult nonpsychiatric interventions.

Nursing in child psychiatric milieus: Part I: What nurses do.

Abstract: Because of the reduced length of inpatient hospitalization and the increasing emphasis on biopsychiatric treatments, milieu psychiatry is in decline. However, certain aspects of the therapeutic milieu are essential to the operation of child inpatient units. Children with acute psychiatric illness need a safe, structured, and supportive environment. Nurses are the professional group responsible for instituting and maintaining this type of environment, yet their specific functions are vaguely stated and often intuitively derived. A useful way to delineate and describe what nurses do is to organize nursing behaviors into five therapeutic processes: (a) safety, (b) structure, (c) support, (d) involvement, and (e) validation. By delineating essential milieu dimensions in this way, the form and purpose of nursing interventions are clarified.

Informed consent with children and adolescents.

Abstract: Nurses are becoming increasingly responsible for obtaining consent from children and adolescents for psychiatric treatment. The current practice of obtaining consent for participation in research is discussed. Consent from minors has implications for clinical treatment. This article examines power and powerlessness, and restrictiveness of the treatment setting in relation to nurses obtaining consent from children and adolescents.

Nursing in child psychiatric milieus: Part II: Mapping conceptual footholds.

Abstract: In the first part of this paper, child inpatient nursing practice was organized into five therapeutic processes (safety, structure, support, involvement and validation) Using this organization of nursing care, three specific practice question are now addressed One, how will nursing blend their traditional psychosocial orientation with biological psychiatry? Two, how might nurses best respond to the pressure to reduce the length of hospitalization yet still effectively intervene with troubled children? Three, does the traditional milieu therapy model have clinical utility for child inpatient nurses in the 1990's It is suggested that nursing practice is best supported by multiple midrange theories which clarify children's behavior and give theoretical support to specific nursing interventions

Child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment.

Abstract: This study examined the prevalence of child maltreatment, stressful life events, and behavior problems in school-aged children in residential treatment The sample included 44 children, ages 5-13 years; 61% were male and 39% female Results indicated that the entire sample had experienced one or more types of maltreatment, with physical abuse being more prevalent Seventy-four percent of subjects scored in the clinical range on the Child Behavior Checklist (Achenbach & Edelbrock, 1983) Proportionally more physically abused children scored in the clinical range when compared to nonphysically abused children The number of stressful life events experienced after admission to the treatment facility was found to be related to increased behavior problems

Shifting the paradigm: toward integrative research on mothers and children.

Abstract: The mother-child relationship has been examined extensively but most research has centered on maternal characteristics associated with poor childhood developmental outcomes or maternal response to stressors. The "maternal deficit" model has misdirected research and intervention. Research on maternal depression based on the maternal deficit model has resulted in research designs that do not adequately address maternal outcomes. Research must be conceptualized to address parent-child relationships and situational factors that influence them.

In Support of Sibling Inclusion: A Literature Review

Abstract: The responses of siblings to a childhood mental illness have been conceptualized in different ways. When siblings have not been ignored, they have been viewed most frequently as an influence upon the illness or as subject to the same dynamics that were believed to have caused the mental illness. As conceptualizations of the causes of mental illness have changed, the literature on siblings has changed to focus on the impact of the illness on the sibling. How siblings and sibling relationships are conceptualized has important implications for clinical research and practice. More research is needed to understand the sibling experience in childhood mental illness. Clinicians can do more for the family if all of the family dynamics and responses to the illness are explored.

In Defense of Genuine Ignorance: Supporting Vitality and Relevance in Graduate Curricula

Abstract: Genuine ignorance, defined by John Dewey as curiosity and openmindedness in opposition to repetition of catch phrases and familiar propositions, is nurtured in graduate nursing curricula in which the educational process is congruent with course content. Preparation for advanced practice in the mental health environment of the foreseeable future requires abandonment of the familiar medical model in favor of conceptual models consistent with current thinking in psychiatric nursing and exposure to current problems (homelessness, family violence, AIDS) and current problem solving strategies (brief treatment, family preservation). Involvement in practice-based research and operationalizing new perspectives on familiar clinical problems, are suggested as strategies for developing the advanced practitioner. Two of the authors, former graduate students, describe the impact of changed perspectives and research activity on their own practice. Genuine ignorance is profitable because it is likely to be accompanied by humility, curiosity, and openmindedness, whereas ability to repeat catch phrases, cant terms, and familiar propositions, gives the conceit of learning and coats the mind with varnish waterproof to new ideas. John Dewey

Nurses Develop a Plan for Research on Child and Adolescent Mental Disorders

Abstract: JCPN Commentary presents a series of observations, opinions, and analyses of issues and trends in education and practice in psychiatric and mental health nursing, and social policy factors that influence families, or the delivery of health services to youth and their families.

The Attending Nurse: A New Role for the Advanced Clinician

Abstract: The Attending Nurse Model as a unique role for the advanced practitioner was implemented and evaluated in an acute care psychiatric setting with an adolescent patient population Program evaluation results demonstrated that the Attending Nurse role increased general satisfaction and role clarity while decreasing role tension In addition, the role increased communication with patients' family members Comparisons are made between the traditional primary nurse and the Attending Nurse roles

A symptom management program for adolescents with psychotic illnesses: theoretical basis.

Abstract: The author describes the theoretical basis of a nursing intervention program for adolescents who have experienced nondrug-related psychotic episodes. The program is designed to empower mentally ill adolescents and to increase their level of functioning by assisting them to recognize and manage symptoms of their illnesses. The theoretical model predicts some factors that influence the adolescent's level of functioning.

The challenge of ritualistic child abuse.

Abstract: Survivors of ritual abuse have endured physical and psychosexual trauma typically compounded by mind-altering drugs. Some abused children have never known a trustworthy adult to protect them from harm. Children often cope with the anxiety and terror of abuse through psychological defenses such as denial, self-hypnosis, and dissociation, but more extreme responses such as self-mutilation or multiple personalities may occur. Reports of ritual abuse of children are so shocking and bizarre that professionals initially respond with confusion and disbelief (Cozolino, 1989). Nurses need to assess clues and detect symbols of abuse in drawings or flashbacks, to build trust, and to monitor their attitudes and countertransference. Nurses are in a critical position to detect and begin healing wounds of ritual abuse.

Uses and implications of the contextual approach to child custody decisions.

Abstract: Child custody litigation signals parental conflicts that have serious implications for a child's long-term development. The authors describe a family systems approach to child custody decision making--the contextual approach, derived from contextual family theory. A case study analysis and pilot study illustrate the use of the approach with a small group of families who turn to the legal system to resolve custody or visitation disputes. The findings suggest the approach's usefulness in helping families create alternatives to continued disputation. The findings also reinforce the need for further research to test the preventive potential of the approach in reducing returns to court.

Preparing to parent the adolescent: a theoretical overview.

Abstract: Early adolescence (ages 11-14 years) occurs at the time most parents are in middle adulthood. The tasks of both early adolescent and middle adulthood stages are numerous and complex. As a societal unit, the family is challenged to meet one another's needs for cohesion, adaptability, and satisfaction. Family communication and the family's ability to resolve conflicts are proposed as facilitating factors to meet these challenges.

A symptom management program for psychotically ill adolescents and their families: preliminary clinical outcomes.

Abstract: The author describes the preliminary results of a clinical pilot study of a symptom management program for adolescents who are recovering from a nondrug-induced psychotic episode. The program was designed as a follow-up treatment for adolescents who are living at home with their families. Preliminary findings showed that the program was effective in increasing the adolescents' ability to recognize symptoms of their illnesses and to develop coping strategies to manage their symptoms.

Mental health care rights of adolescents: what mental health nurses need to know.

Abstract: Adolescents have certain rights regarding mental health care. There is a need for healthcare professionals, including nurses, to become more aware and knowledgeable of these rights. This article reviews the medical/legal rights of adolescents and their parents, and presents a history of relevant changes that have occurred in the parent-child relationship. It discusses also current issues pertinent to the mental health care of adolescents and identifies researchable questions.

Multiple family therapy for adolescents: a case illustration.

Abstract: Psychiatric hospitalization of adolescents is on the rise, with the concurrent trend toward shorter stays and increased need for expedient, effective treatment modalities. Involving families or troubled adolescents in all phases of treatment is believed to be essential and aids both in successful reintegration of the patient into the community and prevention of relapse. Psychiatric nurses can practice innovative therapies to meet the needs of hospitalized adolescents and their families. Clinical observations have shown multiple family therapy for adolescents to be a valuable component of care.

Difficulties with teens: can nursing consultation help?

Abstract: Child/youth problems and psychiatric hospitalizations are increasing. A literature review suggests that there is an increased need for more nurses with the knowledge and skills necessary to work in this specialty area. The review also suggests that providing psychiatric nursing consultation services is one way to help direct care staff to strengthen or develop these skills. The authors describe a consultation project that took place on a newly developed 15-bed adolescent program in a 30-bed private psychiatric hospital. They examine the effectiveness of consultation sessions, ascertained through both verbal and written evaluations of staff members. The outcome suggests that psychiatric nursing consultation services can be an important contribution in expanding the knowledge base of direct care staff (child care specialists and nurses) who work with the hospitalized adolescent psychiatric patient.